,i #aafth ,,congress #ast ,session ,h4 ,r4 #ddhd ,,in ,,the ,,house ,,of ,,representatives ,september #be1 #bjai,mr4 ,budd 7for himself and ,mr4 ,harris7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,education and ,labor1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to require short-term limited duration insurance issuers to renew or continue in force such insurance coverage at the option of the enrollees1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,flexibility ,through ,lower ,expenses ,health ,care ,act or the ,,flex ,act4 #b4 ,short-term limited duration insurance defined 7a7 ,in general ,section #bgia7;b7 of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #cjj;gg-#ia7;b77 is amended by adding at the end the following3 7#f7 ,short-term limited duration insurance ,the term short-term limited duration insurance means health insurance coverage provided pursuant to a contract with a health insurance issuer that has an expiration date specified in the contract 7not taking into account any extensions that may be elected by the policyholder with or without the issuer's consent7 that is less than #ab months after the original effective date of the contract4 4 7b7 ,applicability ,the amendments made by this subsection shall apply with respect to contracts for short-term limited duration insurance that take effect on or after ,january #a1 #bjbj4 #c4 ,definition of employer under ,,erisa with respect to group health plans 7a7 ,definition of employer ,section #c7e7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb7e77 is amended by striking the period and inserting 7which1 with respect to a group health plan1 shall be determined in accordance with criteria that includes the criteria under section #gce744 7b7 ,group health plans 7#a7 ,in general ,part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha et seq47 is amended by adding at the end the following3 #gce4 ,definition of employer with respect to group health plans 7a7 ,in general ,a group or association of employers that meets the criteria under subsection 7b7 shall be considered an employer under section #c7e7 for purposes of sponsoring a group health plan4 7b7 ,requirements ,the requirements under this subsection are each of the following3 7#a7 ,the primary purpose of the group or association may be to offer and provide health coverage to its employer members and their employees1 if such group or association has at least #a substantial business purpose1 as described in subsection 7c71 unrelated to offering and providing health coverage or other employee benefits to its employer members and their employees4 7#b7 ,each employer member of the group or association participating in the group health plan is a person acting directly as an employer of at least #a employee who is a participant covered under the plan4 7#c7 ,the group or association has-- 7,a7 a formal organizational structure with a governing body2 and 7,b7 by-laws or other similar indications of formality4 7#d7 ,the functions and activities of the group or association shall be controlled by the employer members of the group or association1 and the employer members of the group or association that participate in the group health plan shall control the plan4 ,control under this paragraph shall be in form and substance4 7#e7 ,the employer members shall have a commonality of interest as described in subsection 7d74 7#f7 7,a7 ,the group or association shall not make health coverage through the group health plan available other than to-- 7i7 an employee of a current employer member of the group or association2 7ii7 a former employee of a current employer member of the group or association who became eligible for coverage under the group health plan when the former employee was an employee of the employer2 and 7iii7 a beneficiary of an individual described in clause 7i7 or 7ii71 such as a spouse or dependent child4 7,b7 ,notwithstanding subparagraph 7,a71 the group or association shall not make health coverage through the group health plan available to any individual 7or beneficiaries of the individual7 for any plan year following the plan year in which the plan determines pursuant to reasonable monitoring procedures described in subsection 7f77#b77;,c7 that the individual ceases to meet the conditions described in subsection 7f77#b7 for being a working owner 7unless the individual again meets those conditions71 except as may be required by section #fja4 7#g7 ,the group or association1 and any health coverage offered by the group or association1 shall comply with the nondiscrimination provisions under subsection 7e74 7#h7 ,the group or association shall not be a health insurance issuer1 or owned or controlled by such a health insurance issuer or by a subsidiary or affiliate of such a health insurance issuer1 other than to the extent such entities participate in the group or association in their capacity as employer members of the group or association4 7c7 ,substantial business purpose 7#a7 ,in general ,for purposes of subsection 7b77#a71 a substantial business purpose shall exist if the group or association would be a viable entity in the absence of sponsoring an employee benefit plan4 7#b7 ,business purpose ,for purposes of subsection 7b77#a7 and paragraph 7#a71 a business purpose shall-- 7,a7 include promoting common business interests of the members of the group or association or the common economic interests in a given trade or employer community2 and 7,b7 not be required to be a for-profit activity4 7d7 ,commonality of interest 7#a7 ,in general ,subject to paragraph 7#c71 employer members of the group or association shall be treated as having a commonality of interest for purposes of subsection 7b77#e7 if-- 7,a7 the employers are in the same trade1 industry1 line of business1 or profession2 or 7,b7 each employer has a principal place of business in the same region that does not exceed the boundaries of a single ,state or a metropolitan area 7even if the metropolitan area includes more than #a ,state74 7#b7 ,same trade1 industry1 or line of business ,in the case of a group or association that is sponsoring a group health plan under this section and that is itself an employer member of the group or association1 the group or association shall be deemed for purposes of paragraph 7#a77;,a7 to be in the same trade1 industry1 line of business1 or profession1 as applicable1 as the other employer members of the group or association4 7#c7 ,nondiscrimination ,the standards under paragraph 7#a7 shall not be implemented in a manner that is subterfuge for discrimination as is prohibited under subsection 7e74 7e7 ,nondiscrimination 7#a7 ,in general ,a group or association of employers sponsoring a group health plan under this section1 and any health coverage sponsored by such group or association1 shall comply with each of the following3 7,a7 ,the group or association shall not condition employer membership in the group or association on any health factor of any individual who is or may become eligible to participate in the group health plan sponsored by the group or association4 7,b7 ,the group health plan sponsored by the group or association shall comply with the rules under section #beij4gjb7;b7 of title #bi1 ,code of ,federal ,regulations 7as in effect on ,june #ba1 #bjah71 with respect to nondiscrimination in rules for eligibility for benefits1 subject to subparagraph 7,d74 7,c7 ,the group health plan sponsored by the group or association shall comply with the rules under section #beij4gjb7;c7 of title #bi1 ,code of ,federal ,regulations 7as in effect on ,june #ba1 #bjah71 with respect to nondiscrimination in premiums or contributions required by any participant or beneficiary for coverage under the plan1 subject to subparagraph 7,d74 7,d7 ,in applying subparagraphs 7,b7 and 7,c71 the group or association may not treat the employees of different employer members of the group or association as distinct groups of similarly situated individuals based on a health factor of #a or more individuals4 7#b7 ,definition of health factor ,for purposes of this subsection1 the term health factor has the meaning given such term in section #beij4gjb7;a7 of title #bi1 ,code of ,federal ,regulations 7as in effect on ,june #ba1 #bjah74 7f7 ,dual treatment of working owners as employers and employees 7#a7 ,in general ,a person determined in accordance with paragraph 7#b7 to be a working owner of a trade or business may qualify as both an employer and as an employee of the trade or business for purposes of the requirements under subsection 7b71 including the requirements under paragraphs 7#b7 and 7#f7 of such subsection4 7#b7 ,working owner 7,a7 ,eligibility ,a person shall qualify as a working owner if a responsible fiduciary of the group health plan reasonably determines that the person-- 7i7 does not have any common law employees2 7ii7 has an ownership right of any nature in a trade or business1 whether incorporated or unincorporated1 including a partner and other self-employed individual2 7iii7 is earning wages or self-employment income from the trade or business for providing personal services to the trade or business2 and 7iv7 either-- 7,i7 works on average at least #bj hours per week1 or at least #hj hours per month1 providing personal services to the person's trade or business2 or 7,,ii7 has wages or self-employment income from such trade or business that at least equals the person's cost of coverage for participation by the person1 and any covered beneficiaries1 in the group health plan sponsored by the group or association in which the person is participating4 7,b7 ,determination ,the determination under subparagraph 7,a7 shall be made when the person first becomes eligible for coverage under the group health plan4 7,c7 ,reasonable monitoring procedures ,a responsible fiduciary of the group health plan shall1 through reasonable monitoring procedures1 periodically confirm the continued eligibility of a person to qualify as a working owner under subparagraph 7,a7 for purposes of meeting the requirements under subsection 7b7 for the group health plan sponsored under this section4 7g7 ,applicability 7#a7 ,fully insured ,this section shall apply beginning on ,september #a1 #bjbj1 with respect to a group or association of employers sponsoring a group health plan that is fully insured4 7#b7 ,plans expanding to include broader group ,this section shall apply beginning on ,january #a1 #bjbj1 with respect to a group or association of employers sponsoring a group health plan that-- 7,a7 is not fully insured2 7,b7 was in existence on ,june #ba1 #bjah2 7,c7 meets the requirements that applied with respect to such plan before ,june #ba1 #bjah2 and 7,d7 chooses to be a plan sponsored under this section 7and subject to the requirements under subsections 7b7 through 7f774 7#c7 ,other association health plans ,this section shall apply beginning on ,april #a1 #bjbj1 with respect to any other group or association of employers sponsoring a group health plan4 7#d7 ,other criteria in advisory opinions ,the criteria under this section shall not invalidate any criteria provided in an advisory opinion1 in effect on or after the date of enactment of the ,,flex ,act1 that the ,secretary may use to determine if a group or association of employers is an employer under section #c7e7 for purposes of sponsoring a group health plan4 7h7 ,determination of employer or joint employer status 7#a7 ,in general ,participating in or facilitating a group health plan sponsored by a bona fide group or association of employers pursuant to subsection 7a7 shall not be construed as establishing an employer or joint employer relationship under any ,federal or ,state law4 7#b7 ,application of provision ,paragraph 7#a7 shall apply to a group health plan sponsored or facilitated by a franchisor and any franchisee1 by multiple franchisors for the benefit of the employees of such franchisors and their franchisees1 by multiple franchisees for the benefit of the employees of such franchisees1 by a franchisor whose franchisee or franchisees participate or participates in the plan1 or by a person or entity that contracts with any individual as an independent contractor for whom the plan benefits4 7i7 ,rule of construction ,nothing in this section shall be construed as repealing or otherwise limiting the application of this ,act 7including section #gab relating to mental health parity7 to group health plans and employee welfare benefit plans4 4 7#b7 ,clerical amendment ,the table of contents in section #a of the ,employee ,retirement ,income ,security ,act of #aigd is amended by inserting after the item relating to section #gcd the following new item3 ,sec4 #gce4 ,definition of employer with respect to group health plans4 4