,,ii  #aaf? ,,congress  #b;d ,session   
,s4 #cfaj  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,may #e1 #bjbj,mr4     
,paul 7= himself1 ,mr4 ,romney1 ,mr4    
,lank=d1 ,mrs4 ,blackburn1 ,ms4 ,ern/1  
,mr4 ,braun1 & ,mr4 ,sasse7 introduc$ ! 
foll[+ bill2 :i* 0 read twice & ref]r$  
to ! ,committee on ,heal?1 ,education1  
,labor1 & ,p5sions  ,a ,,bill  ,to am5d 
! ,employee ,retirem5t ,income ,security
 ,act ( #aigd to all[ heal? %>e pools to
 be deem$ an employ] "u section #c7e7 ( 
su* ,act = purposes ( (f]+ a gr\p heal? 
plan or gr\p heal? insurance cov]age1 & 
= o!r purposes4  #a4 ,%ort title ,?is   
,act may be cit$ z ! ,am]ican ,heal?%>e 
,plans ,act ( #bjbj4  #b4 ,heal?%>e     
pools deem$ an employ] = purposes ( (f]+
 gr\p heal? plans or gr\p heal?         
insurance cov]age  7a7 ,def9ition (     
employ] ,section #c7e7 ( ! ,employee    
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #ajjb7e77 is am5d$ 
by add+ at ! end ! foll[+3 ,su* t]m %all
 be deem$ to include1 = purposes ( (f]+ 

a gr\p heal? plan 7z def9$ 9 section    
#gcc7;a77#a77 or gr\p heal? insurance   
cov]age 7z def9$ 9 section #gcc7;b77#d77
 7:i*1 not)/&+ any o!r provision ( law1 
may include su* a plan or cov]age cov]+ 
prescription or nonprescription drugs z 
! only b5efit (f]$ by ! plan or cov]age 
9 accordance ) section                  
#gce7;b77#e77;,b771 any entity t meets !
 requirem5ts "u section #gce7;b744  7b7 
,gr\p heal? plans & gr\p heal? insurance
 cov]age ,"p #g ( subtitle ,b ( title ,i
 ( ! ,employee ,retirem5t ,income       
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#aaha et seq47 is am5d$ by add+ at ! end
 ! foll[+3  #gce4 ,heal?%>e pools deem$ 
an employ] = purposes ( (f]+ gr\p heal? 
plans or gr\p heal? insurance cov]age   
7a7 ,9 g5]al ,an entity 7ref]r$ to 9 ?is
 section z a heal?%>e pool7 t meets !   
requirem5ts "u subsection 7b7 %all be   
deem$ an employ] "u section #c7e7 =     
purposes ( (f]+ a gr\p heal? plan or    
gr\p heal? insurance cov]age 7:i*1      
not)/&+ any o!r provision ( law1 may    

include su* a plan or cov]age cov]+     
prescription or nonprescription drugs z 
! only b5efit (f]$ by ! plan or cov]age 
9 accordance ) subsection 7b77#e77;,b774
  7b7 ,requirem5ts = heal?%>e pools ,!  
requirem5ts "u ?is subsection are ea* ( 
! foll[+3 7#a7 ,organization ,! heal?%>e
 pool %all-- 7,a7 be =m$ & ma9ta9$ 9    
good fai? = a purpose t includes !      
=mation ( a risk pool 9 ord] to (f] gr\p
 heal? insurance cov]age or a gr\p heal?
 plan to its memb]s2 &  7,b7 n condition
 memb]%ip 9 ! heal?%>e pool on any heal?
 /atus-relat$ factor relat+ to an       
individual 7includ+ an employee ( an    
employ] or a dep5d5t ( an employee74    
7#b7 ,(f]+ gr\p heal? plans & gr\p heal?
 insurance cov]age  7,a7 ,diff]5t gr\ps 
7i7 ,9 g5]al ,! heal?%>e pool1 :i* may  
be 9 conjunction ) a heal? insurance    
issu] t (f]s gr\p heal? insurance       
cov]age ?r\gh ! heal?%>e pool1 %all make
 available a gr\p heal? plan or gr\p    
heal? insurance cov]age to all memb]s ( 
! heal?%>e pool 7&1 9 ! case ( memb]s t 

are employ]s1 employees ( ! employ]s7 at
 rates t-- 7,i7 are e/abli%$ by !       
heal?%>e pool1 or a heal? insurance     
issu] contract+ ) su* heal?%>e pool1 on 
a policy or product specific basis2 &   
7,,ii7 subject to sections #gja & #gjb1 
may v>y = individuals cov]$ ?r\gh !     
heal?%>e pool4  7ii7 ,p]missible cov]age
 = dep5d5ts ,su* gr\p heal? plan or gr\p
 heal? insurance cov]age may be made    
available "u clause 7i7 to any dep5d5ts 
( memb]s ( ! heal?%>e pool or dep5d5ts (
 employees ( employ]s t are su* memb]s4 
7,b7 ,nondiscrim9ation 9 cov]age (f]$   
7i7 ,9 g5]al ,subject to clause 7ii71 ! 
heal?%>e pool may n (f] cov]age "u a    
gr\p heal? plan or gr\p heal? insurance 
cov]age to a memb] ( ! heal?%>e pool    
unless ! same cov]age is (f]$ to all su*
 memb]s ( ! heal?%>e pool4  7ii7        
,con/ruction ,no?+ 9 ?is subsection %all
 be con/ru$ z requir+ a heal? insurance 
issu] or gr\p heal? plan to provide     
cov]age outside ! s]vice area ( ! issu] 
or plan1 or prev5t+ a heal? insurance   

issu] or gr\p heal? plan f und]writ+ or 
f exclud+ or limit+ ! cov]age on any    
individual1 subject to ! requirem5ts "u 
sections #gja & #gjb4  7,c7 ,assumption 
( risk ,! heal?%>e pool may provide--   
7i7 gr\p heal? insurance cov]age ?r\gh a
 contract ) a heal? insurance issu]2 or 
7ii7 a gr\p heal? plan ?r\gh            
self-insurance4  7#c7 ,geographic areas 
,no?+ 9 ?is subsection %all be con/ru$ z
 prev5t+ ! e/abli%m5t & op]ation ( m ?an
 #a heal?%>e pool 9 a geographic area or
 z limit+ ! numb] ( heal?%>e pools t may
 op]ate 9 any area4  7#d7 ,provision (  
adm9i/rative s]vices to pur*as]s ,!     
heal?%>e pool may provide adm9i/rative  
s]vices = memb]s4 ,su* s]vices may      
include acc\nt+1 bill+1 & enrollm5t     
in=mation4  7#e7 ,drug cov]age ,! gr\p  
heal? plan or gr\p heal? insurance      
cov]age (f]$ by ! heal?%>e pool may     
(f]-- 7,a7 drug cov]age1 includ+ cov]age
 ( ov]-!-c\nt] drugs1 9 comb9ation ) o!r
 b5efits cov]$ by ! gr\p heal? plan or  
gr\p heal? insurance cov]age2 or  7,b7  

not)/&+ any o!r provision ( law1 drug   
cov]age1 includ+ cov]age ( ov]-!-c\nt]  
drugs1 z ! only b5efit cov]$ by ! gr\p  
heal? plan or gr\p heal? insurance      
cov]age4  7#f7 ,memb]s  7,a7 ,9 g5]al ,)
 respect to an individual :o is a memb] 
( ! heal?%>e pool-- 7i7 ! individual may
 enroll = cov]age "u ! gr\p heal? plan  
or gr\p heal? insurance cov]age (f]$ by 
! heal?%>e pool 7includ+1 if applicable1
 enrollm5t = cov]age = a dep5d5t ( su*  
individual72 or  7ii7 ! employ] ( !     
individual may enroll ! individual =    
cov]age "u ! gr\p heal? plan or gr\p    
heal? insurance cov]age (f]$ by !       
heal?%>e pool 7includ+1 if applicable1  
enrollm5t = cov]age = a dep5d5t ( su*   
individual74  7,b7 ,eligibility ,an     
individual %all be eligible to be a     
memb] ( ! heal?%>e pool if su*          
individual is-- 7i7 a memb] ( an entity 
t e/abli%es or jo9s ! heal?%>e pool 7or 
a dep5d5t ( su* a memb]1 z applicable72 
7ii7 an employee ( a memb] ( an entity  
describ$ 9 clause 7i7 7or a dep5d5t (   

su* an employee1 z applicable72 or      
7iii7 an employee ( an entity 7or a     
dep5dant ( su* an employee1 z           
applicable7 controll$ by a memb] ( an   
entity describ$ 9 clause 7i74  7,c7     
,rules = enrollm5t ,no?+ 9 ?is p>agraph 
%all preclude ! heal?%>e pool f e/abli%+
 rules ( enrollm5t & re5rollm5t (       
memb]s4 ,su* rules %all be appli$       
consi/5tly to all memb]s )9 ! heal?%>e  
pool & %all n be bas$ 9 any mann] on    
heal? /atus-relat$ factors 9 accordance 
) sections #gja & #gjb4  7c7            
,det]m9ation ( employ] & jo9t employ]   
/atus ,p>ticipat+ 9 or facilitat+ a gr\p
 heal? plan or gr\p heal? insurance     
cov]age "u ?is section %all n be con/ru$
 z e/abli%+ "u any ,f$]al or ,/ate law--
 7#a7 an employ] relation%ip = any      
purpose o!r ?an (f]+ ! gr\p heal? plan  
or gr\p heal? insurance cov]age2 or     
7#b7 a jo9t employ] relation%ip = any   
purpose4  7d7 ,def9ition ,9 ?is section1
 ! t]m dep5d5t1 z appli$ to a gr\p heal?
 plan or gr\p heal? insurance cov]age   

(f]$ 9 a ,/ate1 %all h ! mean+ appli$ to
 su* t]m ) respect to su* plan or       
cov]age "u ! ,/ate law apply+ to su*    
plan or cov]age4 ,su* t]m may include ! 
sp\se & *ildr5 ( ! individual involv$ 9 
accordance ) su* ,/ate law4  4  #c4     
,con=m+ am5dm5ts ,section #c ( !        
,employee ,retirem5t ,income ,security  
,act ( #aigd 7#bi ,u4,s4,c4 #ajjb7 is   
am5d$-- 7#a7 9 p>agraph 7#f71 by ins]t+ 
be=e ! p]iod 1 except 7) respect to an  
entity meet+ ! requirem5ts "u section   
#gce7;b77 su* t]m includes any memb] (  
su* entity2  7#b7 9 p>agraph 7#ba7--    
7,a7 9 subp>agraph 7,a71 by /rik+       
subp>agraph 7,b7 & ins]t+ subp>agraphs  
7,b7 & 7,c72 &  7,b7 by add+ at ! end ! 
foll[+3  7,c7 ,) respect to a p]son t is
 a memb] ( an entity 7ref]r$ to 9       
section #gce & ?is subp>agraph z a      
heal?%>e pool7 t meets ! requirem5ts (  
subsection 7b7 ( su* section & (f]s a   
gr\p heal? plan 7z def9$ 9 section      
#gcc7;a77#a77 or gr\p heal? insurance   
cov]age 7z def9$ 9 section #gcc7;b77#d77

 7:i*1 not)/&+ any o!r provision ( law1 
may include su* a plan or cov]age cov]+ 
prescription or nonprescription drugs z 
! only b5efit (f]$ by ! plan or         
cov]age71 memb]%ip 9 ! heal?%>e pool    
%all n by itself cause ! p]son to be a  
fiduci>y ) respect to ! gr\p heal? plan 
or gr\p heal? insurance cov]age4  2 &   
7#c7 9 p>agraph 7#dj77;,a7-- 7,a7 9     
clause 7ii71 by /rik+ 1 or & ins]t+ 12  
7,b7 9 clause 7iii71 by /rik+ ! p]iod & 
ins]t+ 1 or2 &  7,c7 by add+ at ! end ! 
foll[+3  7iv7 z a gr\p heal? plan 7z    
def9$ 9 section #gcc7;a77#a771 or gr\p  
heal? insurance cov]age 7z def9$ 9      
section #gcc7;b77#d771 (f]$ by an entity
 meet+ ! requirem5ts "u section #gce7;b7
 7:i*1 not)/&+ any o!r provision ( law1 
may include su* an entity (f]+ su* a    
plan or cov]age cov]+ prescription or   
nonprescription drugs z ! only b5efit   
(f]$ by ! plan or cov]age74  4