,,ii  #aad? ,,congress  #a/ ,session    
,s4 #afig  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,june #be1 #bjae,mr4   
,grassley 7= himself & ,ms4 ,heitkamp7  
introduc$ ! foll[+ bill2 :i* 0 read     
twice & ref]r$ to ! ,committee on       
,f9ance  ,a ,,bill  ,to provide an      
exception f c]ta9 gr\p heal? plan       
requirem5ts to all[ small bus9esses to  
use pre-tax doll>s to assi/ employees 9 
! pur*ase ( policies 9 ! individual     
heal? insurance m>ket1 & = o!r purposes4
  #a4 ,%ort title ,?is ,act may be cit$ 
z ! ,small ,bus9ess ,heal?c>e ,relief   
,act4  #b4 ,exception f gr\p heal? plan 
requirem5ts to all[ small bus9esses to  
use pre-tax doll>s to assi/ employees 9 
! pur*ase ( heal? insurance 9 !         
individual m>ket  7a7 ,am5dm5ts to !    
,int]nal ,rev5ue ,code ( #aihf & !      
,pati5t ,protection & ,af=dable ,c>e    
,act  7#a7 ,9 g5]al ,section #ihca ( !  
,int]nal ,rev5ue ,code ( #aihf is am5d$ 
by add+ at ! end ! foll[+ new           
subsection3  7d7 ,c]ta9 individual heal?

 insurance policies obta9$ ?r\gh small  
employ]s  7#a7 ,9 g5]al ,! requirem5ts (
 ?is *apt] %all n apply to any qualifi$ 
small employ] heal? reimbursem5t        
arrangem5t4  7#b7 ,qualifi$ small       
employ] heal? reimbursem5t arrangem5t ,=
 purposes ( ?is subsection-- 7,a7 ,9    
g5]al ,! t]m qualifi$ small employ]     
heal? reimbursem5t arrangem5t means an  
arrangem5t :i*--  7i7 is describ$ 9     
subp>agraph 7,b71 &  7ii7 is (f]$ on !  
same t]ms to all eligible employees ( ! 
eligible employ]4  7,b7 ,arrangem5t     
describ$ ,an arrangem5t is describ$ 9   
?is subp>agraph if-- 7i7 su* arrangem5t 
is fund$ solely by an eligible employ] &
 no sal>y r$uction contributions may be 
made "u su* arrangem5t1 &  7ii7 su*     
arrangem5t provides1 aft] ! employee    
provides pro( ( cov]age to ! employ]1 = 
! paym5t (1 or reimbursem5t (1 an       
eligible employee =--  7,i7 exp5ses =   
m$ical c>e 7z def9$ by subp>agraphs     
7,a71 7,b71 & 7,c7 section #bac7;d77    
incurr$ by ! eligible employee or !     

eligible employee's family memb]s 7z    
det]m9$ "u ! t]ms ( ! arrangem5t71 &    
7,,ii7 includ+ =-- 7aa7 insurance 7)9 ! 
mean+ ( section #bac7;d77#a77;,d77      
pur*as$ on ! individual heal? insurance 
m>ket1 &  7bb7 premiums "u "p ,b ( title
 ,,xviii ( ! ,social ,security ,act &   
any m$ic>e supplem5tal policy "u section
 #ahhb ( su* ,act4  7,c7 ,paym5ts = o!r 
insurance n p]mitt$ "u arrangem5t ,an   
arrangem5t %all n be treat$ z describ$ 9
 subp>agraph 7,b7 if ! arrangem5t p]mits
 ! employee to pay premiums = heal?     
insurance cov]age = ! employee "u !     
employee's sp\se or o!r family memb]    
heal? insurance cov]age4  7,d7 ,c]ta9   
v>iation p]mitt$ ,= purposes (          
subp>agraph 7,a77ii71 an arrangem5t %all
 n fail to be treat$ z (f]$ on ! same   
t]ms to all eligible employees m]ely    
because ! employ] contributions "u su*  
arrangem5t v>y bas$ on ! numb] (        
individuals cov]$ "u su* policy4 ,!     
prec$+ s5t5ce %all n apply unless su*   
v>iation is consi/5tly appli$ to all    

eligible employees & is consi/5t ) !    
price v>iation ( cov]age "u heal?       
insurance obta9$ 9 ! relevant individual
 heal? insurance m>ket4  7#c7 ,o!r      
def9itions ,= purposes ( ?is            
subsection-- 7,a7 ,eligible employee ,! 
t]m eligible employee means any employee
 ( ! employ] except t ! t]ms ( !        
arrangem5t may exclude f consid]ation   
employees describ$ 9 any clause (       
section #aje7;h77#c77;,b7 7appli$ by    
sub/itut+ #ij days = #c ye>s 9 clause   
7i7 !re(74  7,b7 ,eligible employ] ,!   
t]m eligible employ] means an employ]   
t-- 7i7 is n an applicable l>ge employ] 
z def9$ 9 section #dihj;,h7c77#b71 &    
7ii7 does n (f] a gr\p heal? plan 7o!r  
?an a qualifi$ small employ] heal?      
reimbursem5t arrangem5t7 to any ( its   
employees4  7,c7 ,individual heal?      
insurance policy ,! t]m individual heal?
 insurance policy means individual heal?
 insurance cov]age 7z def9$ 9 section   
#bgia7;b7 ( ! ,public ,heal? ,s]vice    
,act7 :i* is (f]$ by a heal? insurance  

issu] 7z s def9$ 9 su* section74  4     
7#b7 ,exclusion f gross income ,section 
#ajf ( su* ,code is am5d$ by add+ at !  
end ! foll[+3  7g7 ,qualifi$ small      
employ] heal? reimbursem5t arrangem5t   
7#a7 ,9 g5]al ,9 ! case ( an individual 
:o is an eligible employee 7z def9$ 9   
p>agraph 7#c77;,a7 ( section #ihca7;d77 
) respect to an eligible employ] 7z     
def9$ 9 p>agraph 7#c77;,b7 ( su*        
section71 ! applicable p]c5tage ( !     
aggregate contributions made = ! taxable
 ye> by ! eligible employ] "u a qualifi$
 small employ] heal? reimbursem5t       
arrangem5t 7z def9$ 9 p>agraph 7#b7 (   
su* section7 ) respect to ! employee    
%all be treat$ z employ]-provid$ cov]age
 = m$ical exp5ses "u an accid5t or heal?
 plan4  7#b7 ,applicable p]c5tage ,=    
purposes ( p>agraph 7#a7 ! applicable   
p]c5tage %all be-- 7,a7 #be p]c5t if !  
employee is cov]$ = less ?an #c mon?s 9 
! taxable ye> by ! qualifi$ small       
employ] heal? reimbursem5t arrangem5t & 
! employee draws am\nts f ! arrangem5t 9

 any mon? dur+ :i* ! employee is n s    
cov]$1  7,b7 #ej p]c5t if ! employee is 
cov]$ = m ?an #c mon?s b less ?an #f    
mon?s 9 ! taxable ye> by ! qualifi$     
small employ] heal? reimbursem5t        
arrangem5t & ! employee draws am\nts f !
 arrangem5t 9 any mon? dur+ :i* !       
employee is n s cov]$1  7,c7 #ge p]c5t  
if ! employee is cov]$ = m ?an #f mon?s 
b less ?an #i mon?s 9 ! taxable ye> by !
 qualifi$ small employ] heal?           
reimbursem5t arrangem5t & ! employee    
draws am\nts f ! arrangem5t 9 any mon?  
dur+ :i* ! employee is n s cov]$1 &     
7,d7 #ajj p]c5t if ! employee is cov]$ =
 m ?an #i mon?s 9 ! taxable ye> by !    
qualifi$ small employ] heal?            
reimbursem5t arrangem5t4  7#c7 ,rule =  
special enrollm5t ,9 ! case ( an        
employee :o fir/ becomes cov]$ "u !     
qualifi$ small employ] heal?            
reimbursem5t arrangem5t by reason (     
enrollm5t dur+ a special enrollm5t p]iod
 = qualify+ ev5ts 7"u section #fjc (    
,employee ,retirem5t ,income & ,security

 ,act71 9 lieu ( p>agraph 7#b7 !        
applicable p]c5tage %all be ! ratio     
7express$ z a p]c5tage7 t--  7,a7 !     
numb] ( ! mon?s 9 ! taxable ye> = :i*   
su* employee is cov]$ by su* arrangem5t1
 be>s to  7,b7 ! total numb] ( mon?s 9 !
 taxable ye> = :i* su* employee is      
eligible to be cov]$ by su* arrangem5t4 
4  7#c7 ,exception f cont9uation cov]age
 requirem5ts ,section #dihj;,b7d7 ( su* 
,code is am5d$ by /rik+ or at ! end (   
p>agraph 7#b71 by /rik+ ! p]iod at ! end
 ( p>agraph 7#c7 & ins]t+ 1 or1 & by    
add+ at ! end ! foll[+ new p>agraph3    
7#d7 any qualifi$ small employ] heal?   
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b774  4  7#d7        
,exception f excise tax on high co/     
employ]-sponsor$ heal? cov]age ,section 
#dihj;,i7d77#b7 ( su* ,code is am5d$ by 
r$esignat+ subp>agraph 7,d7 z           
subp>agraph 7,e7 & by ins]t+ aft]       
subp>agraph 7,c7 ! foll[+3  7,d7 ,9 !   
case ( applicable employ]-sponsor$      
cov]age consi/+ ( cov]age "u any        

qualifi$ small employ] heal?            
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b771 ! co/ ( !       
cov]age %all be ! am\nt report$ "u      
section #fjea7;a77#ae74  4  7#e7        
,prev5tion ( d\ble b5efit "u heal?      
insurance premium cr$it ,section        
#cf;,b7c77#b7 ( su* ,code is am5d$ by   
add+ at ! end ! foll[+ new subp>agraph3 
7,e7 ,special rule = c]ta9 individual   
heal? insurance policies obta9$ ?r\gh   
small employ]s  7i7 ,9 g5]al ,! t]m     
cov]age mon? %all n include any mon? )  
respect to an employee if = su* mon? !  
employee is (f]$ af=dable cov]age "u an 
individual heal? insurance policy 7z    
def9$ "u section #ihca7;d77#c77;,c77 "u 
a qualifi$ small employ] heal?          
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b774  7ii7 ,af=dable 
,= purposes ( clause 7i71 cov]age %all  
be treat$ z af=dable = a mon? if-- 7,i7 
#a_/ab ( ! employ]'s contribution to !  
employee = a ye> "u su* arrangem5t is n 
less ?an ! am\nt t w\ld be paid by !    

employee = ! premium = su* mon? = !     
applicable second l[e/ co/ self-only    
silv] plan = self-only cov]age ) respect
 to ! employee's individual m>ket1 &    
7,,ii7 ! employee's co/ = cov]age "u !  
individual heal? insurance policy "u !  
qualifi$ small employ] heal?            
reimbursem5t arrangem5t = a ye> does n  
exce$ ! #i4e p]c5t ( ! employee's       
h\sehold income4  4  7#f7 ,employee     
notice ,section #aja ( ! ,employee      
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #ajba7 is am5d$ by 
add+ at ! end ! foll[+3  7o7 ,notice    
relat+ to heal? reimbursem5t arrangem5ts
 ,an employ] ma9ta9+ a qualifi$ small   
employ] heal? reimbursem5t arrangem5t 7z
 def9$ 9 section #ihca7;d77#b7 ( !      
,int]nal ,rev5ue ,code ( #aihf7 %all1 ^u
 an election by an employee to          
p>ticipate 9 su* qualifi$ small employ] 
heal? reimbursem5t arrangem5t1 provide  
notice to ! employee t if ! employee is 
n cov]$ "u su* arrangem5t = at lea/ #i (
 #ab mon?s 9 ! plan ye>1 any funds "u   

su* arrangem5t may be includible 9 gross
 income4  4  7#g7 ,report+  7,a7 ,w-#b  
report+ ,section #fjea7;a7 ( su* ,code  
is am5d$ by /rik+ & at ! end ( p>agraph 
7#ac71 by /rik+ ! p]iod at ! end (      
p>agraph 7#ad7 & ins]t+ 1 &1 & by ins]t+
 aft] p>agraph 7#ad7 ! foll[+ new       
p>agraph3  7#ae7 ! total am\nt ( employ]
 contributions made = ! ye> "u a        
qualifi$ small employ] heal?            
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b77 ) respect to !   
employee4  4  7,b7 ,in=mation requir$ to
 be provid$ by ex*ange subsidy          
applicants  7i7 ,9 g5]al ,section       
#adaa7;b77#c7 ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act is am5d$ by         
r$esignat+ subp>agraph 7,b7 z           
subp>agraph 7,c7 & by ins]t+ aft]       
subp>agraph 7,a7 ! foll[+ new           
subp>agraph3  7,b7 ,c]ta9 individual    
heal? insurance policies obta9$ ?r\gh   
small employ]s ,! mon?s 7if any7 :i* !  
enrollee has or expects to h cov]age "u 
an individual heal? insurance policy 7z 

def9$ 9 section #ihca7;d77#c77;,c7 ( !  
,int]nal ,rev5ue ,code ( #aihf7 provid$ 
"u a qualifi$ small employ] heal?       
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b7 ( su* ,code74  4  
7ii7 ,special rule relat+ to v]ification
 ( in=mation requir$ to be provid$ by   
ex*ange applicants ,v]ification "u      
section #adaa ( ! ,pati5t ,protection & 
,af=dable ,c>e ,act ( in=mation provid$ 
"u section #adaa7;b77#c77;,b7 ( su* ,act
 %all apply ) respect to mon?s beg9n+   
aft] ,octob] #bjaf4  7#h7 ,effective    
date ,! am5dm5ts made by ?is subsection 
%all apply to mon?s beg9n+ aft] ! date (
 ! enactm5t ( ?is ,act4  7b7 ,am5dm5ts  
to ! ,employee ,retirem5t ,income       
,security ,act ( #aigd  7#a7 ,9 g5]al   
,section #gcb ( ! ,employee ,retirem5t  
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aaia;a7 is am5d$ by          
r$esignat+ subsection 7d7 z subsection  
7e7 & by ins]t+ aft] subsection 7c7 !   
foll[+ new subsection3  7d7 ,exception =
 c]ta9 individual heal? insurance       

policies obta9$ ?r\gh small employ]s ,! 
requirem5ts ( ?is "p %all n apply to any
 qualifi$ small employ] heal?           
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b7 ( ! ,int]nal      
,rev5ue ,code ( #aihf74  4  7#b7        
,exception f cont9uation cov]age        
requirem5ts ,section #fja ( su* ,act    
7#bi ,u4,s4,c4 #aafa7 is am5d$ by add+  
at ! end ! foll[+ new subsection3  7c7  
,exception = c]ta9 individual heal?     
insurance policies obta9$ ?r\gh small   
employ]s ,subsection 7a7 %all n apply to
 any qualifi$ small employ] heal?       
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b7 ( ! ,int]nal      
,rev5ue ,code ( #aihf74  4  7#c7        
,exception f c]ta9 o!r gr\p heal? plan  
requirem5ts ,section #fji ( su* ,act    
7#bi ,u4,s4,c4 #aafi7 is am5d$ by       
r$esignat+ subsection 7e7 z subsection  
7f7 & by ins]t+ aft] subsection 7d7 !   
foll[+ new subsection3  7e7 ,exception =
 c]ta9 individual heal? insurance       
policies obta9$ ?r\gh small employ]s ,! 

requirem5ts ( ?is section %all n apply  
to any qualifi$ small employ] heal?     
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b7 ( ! ,int]nal      
,rev5ue ,code ( #aihf74  4  7#d7        
,effective date ,! am5dm5ts made by ?is 
subsection %all apply to mon?s beg9n+   
aft] ! date ( ! enactm5t ( ?is ,act4    
7c7 ,am5dm5ts to ,public ,heal? ,s]vice 
,act  7#a7 ,9 g5]al ,"p ,c ( title      
,,xxvii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;gg-#ia et seq47 is  
am5d$ by add+ at ! end ! foll[+ new     
section3  #bgif4 ,exception = c]ta9     
small employ] plans to provide          
individual heal? insurance policies  7a7
 ,9 g5]al ,! requirem5ts ( ?is title    
%all n apply to any qualifi$ small      
employ] heal? reimbursem5t arrangem5t 7z
 def9$ 9 section #ihca7;d77#b7 ( !      
,int]nal ,rev5ue ,code ( #aihf74  7b7   
,exception n applicable to individual   
heal? insurance (f]$ "u ! plan or       
arrangem5t ,subsection 7a7 %all n apply 
) respect to any individual heal?       

insurance policy 7z def9$ 9 section     
#ihca7;d77#c77;,c7 ( su* ,code7 (f]$ "u 
any su* arrangem5t4  4  7#b7 ,exception 
f cont9uation cov]age requirem5ts ,title
 ,,xxii ( ! ,public ,heal? ,s]vice ,act 
7#db ,u4,s4,c4 #cjj;bb-#a et seq47 is   
am5d$ by add+ at ! end ! foll[+ new     
section3  #bbji4 ,exception = c]ta9     
small employ] plans to provide          
individual heal? insurance policies ,!  
requirem5ts ( ?is title %all n apply to 
any qualifi$ small employ] heal?        
reimbursem5t arrangem5t 7z def9$ 9      
section #ihca7;d77#b7 ( ! ,int]nal      
,rev5ue ,code ( #aihf74  4  7#c7        
,effective date ,! am5dm5ts made by ?is 
subsection %all apply to mon?s beg9n+   
aft] ! date ( ! enactm5t ( ?is ,act4