,,ii  #aag? ,,congress  #a/ ,session    
,s4 #hif  ,,9 ,,! ,,s5ate ,,( ,,!       
,,unit$ ,,/ates  ,m>* #bc1 #bjba,mr4    
,k5n$y introduc$ ! 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 e/abli% additional crit]ia =   
det]m9+ :5 employ]s may jo9 toge!r 9 a  
gr\p or association ( employ]s t w be   
treat$ z an employ] "u section #c7e7 (  
su* ,act = purposes ( sponsor+ a gr\p   
heal? plan1 & = o!r purposes4  #a4 ,%ort
 title ,?is ,act may be cit$ z !        
,association ,heal? ,plans ,act ( #bjba4
  #b4 ,f9d+s ,congress f9ds ! foll[+3   
7#a7 ,association heal? plans all[ small
 bus9esses to b& toge!r on a regional or
 national basis & lev]age _! comb9$ p[] 
to obta9 ! heal? b5efits !y want & ne$1 
at a price !y c af=d4  7#b7 ,small      
bus9ess own]s h exp]i5c$ av]age premium 
decreases ( up to #bi p]c5t "u an       
association heal? plan4  7#c7           

,association heal? plans are gov]n$ "u !
 same rules t apply to employ]-sponsor$ 
insurance arrangem5ts = l>ge employ]s   
utiliz$ by m ?an #afj1jjj1jjj ,am]icans4
  7#d7 ,important consum] protections   
e/abli%$ on a bip>tisan basis "u !      
,employee ,retirem5t & ,income ,security
 ,act ( #aigd1 ! ,heal? ,insurance      
,portability & ,acc\ntability ,act (    
#aiif1 & ! ,consolidat$ ,omnibus ,budget
 ,reconciliation ,act ( #aihe apply to  
association heal? plans4  7#e7          
,association heal? plans comply )       
requirem5ts = l>ge employ] heal? plans  
"u ! ,public ,heal? ,s]vice ,act1 z     
am5d$ by ! ,pati5t ,protection &        
,af=dable ,c>e ,act4  7#f7 ,association 
heal? plans _c limit plan eligibility on
 ! basis ( m$ical hi/ory1 heal? /atus1  
claims exp]i5ce1 or g5etic in=mation4   
7#g7 ,fully insur$ association heal?    
plans mu/ comply ) ,/ate b5efit m&ates4 
7#h7 ,self-insur$ association heal?     
plans are subject to ,/ate              
multiple-employ] welf>e arrangem5t laws4

  7#i7 ,! ,secret>y ( ,labor us$ its    
rulemak+ au?ority to issue a f9al rule  
on ,june #ba1 #bjah1 to exp& access to  
association heal? plans = ,am]ican small
 bus9esses & work+ families1 includ+    
self-employ$ bus9ess own]s4  7#aj7 ,!   
,secret>y ( ,labor requir$ association  
heal? plans =m$ "u ! f9al rule to comply
 ) ev5 /rong] nondiscrim9ation          
protections ?an ! nondiscrim9ation      
protections "u ,f$]al law prior to !    
f9al rule4  7#aa7 ,on ,m>* #bh1 #bjai1 a
 ,f$]al di/rict judge vacat$ ! ,secret>y
 ( ,labor's f9al rule1 ?reat5+ to       
disrupt cov]age = curr5t enrollees &    
re/rict ! ability ( small bus9esses &   
work+ families to b& toge!r to obta9    
af=dable & high quality plans 9 !       
future4  7#ab7 ,heal? c>e is "o ( ! mo/ 
important issues fac+ ,am]ican families1
 & small bus9ess own]s & self-employ$   
,am]icans want secure & af=dable        
association heal? plans to provide      
compreh5sive cov]age = !mselves & _!    
families4  #c4 ,def9ition ( employ] "u  

,,erisa ) respect to gr\p heal? plans   
7a7 ,def9ition ( employ] ,section #c7e7 
( ! ,employee ,retirem5t ,income        
,security ,act ( #aigd 7#bi ,u4,s4,c4   
#ajjb7e77 is am5d$ by /rik+ ! p]iod &   
ins]t+ 7:i*1 ) respect to a gr\p heal?  
plan1 %all be det]m9$ 9 accordance )    
crit]ia t includes ! crit]ia "u section 
#gcf744  7b7 ,gr\p heal? plans ,"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  #gcf4 
,def9ition ( employ] ) respect to gr\p  
heal? plans  7a7 ,9 g5]al ,a gr\p or    
association ( employ]s t meets ! crit]ia
 "u subsection 7b7 %all be consid]$ an  
employ] "u section #c7e7 = purposes (   
sponsor+ a gr\p heal? plan4  7b7        
,requirem5ts ,! requirem5ts "u ?is      
subsection are ea* ( ! foll[+3 7#a7 ,!  
prim>y purpose ( ! gr\p or association  
may be to (f] & provide heal? cov]age to
 its employ] memb]s & _! employees1 if  
su* gr\p or association has at lea/ #a  

sub/antial bus9ess purpose1 z describ$ 9
 subsection 7c71 unrelat$ to (f]+ &     
provid+ heal? cov]age or o!r employee   
b5efits to its employ] memb]s & _!      
employees4  7#b7 ,ea* employ] memb] ( ! 
gr\p or association p>ticipat+ 9 ! gr\p 
heal? plan is a p]son act+ directly z an
 employ] ( at lea/ #a employee :o is a  
p>ticipant cov]$ "u ! plan4  7#c7 ,!    
gr\p or association has-- 7,a7 a =mal   
organizational /ructure ) a gov]n+ body2
 &  7,b7 by-laws or o!r simil>          
indications ( =mality4  7#d7 ,!         
functions & activities ( ! gr\p or      
association %all be controll$ by !      
employ] memb]s ( ! gr\p or association1 
& ! employ] memb]s ( ! gr\p or          
association t p>ticipate 9 ! gr\p heal? 
plan %all control ! plan4 ,control "u   
?is p>agraph %all be 9 =m & sub/ance4   
7#e7 ,! employ] memb]s %all h a         
commonality ( int]e/ z describ$ 9       
subsection 7d74  7#f7 7,a7 ,! gr\p or   
association %all n make heal? cov]age   
?r\gh ! gr\p heal? plan available o!r   

?an to-- 7i7 an employee ( a curr5t     
employ] memb] ( ! gr\p or association2  
7ii7 a =m] employee ( a curr5t employ]  
memb] ( ! gr\p or association :o became 
eligible = cov]age "u ! gr\p heal? plan 
:5 ! =m] employee 0 an employee ( !     
employ]2 &  7iii7 a b5efici>y ( an      
individual describ$ 9 clause 7i7 or     
7ii71 su* z a sp\se or dep5d5t *ild4    
7,b7 ,not)/&+ subp>agraph 7,a71 ! gr\p  
or association %all n make heal? cov]age
 ?r\gh ! gr\p heal? plan available to   
any individual 7or b5efici>ies ( !      
individual7 = any plan ye> foll[+ ! plan
 ye> 9 :i* ! plan det]m9es pursuant to  
reasonable monitor+ proc$ures describ$ 9
 subsection 7f77#b77;,c7 t ! individual 
ceases to meet ! conditions describ$ 9  
subsection 7f77#b7 = be+ a work+ own]   
7unless ! individual aga9 meets ^?      
conditions71 except z may be requir$ by 
section #fja4  7#g7 ,! gr\p or          
association1 & any heal? cov]age (f]$ by
 ! gr\p or association1 %all comply ) ! 
nondiscrim9ation provisions "u          

subsection 7e74  7#h7 ,! gr\p or        
association %all n be a heal? insurance 
issu]1 or own$ or controll$ by su* a    
heal? insurance issu] or by a subsidi>y 
or affiliate ( su* a heal? insurance    
issu]1 o!r ?an to ! ext5t su* entities  
p>ticipate 9 ! gr\p or association 9 _! 
capacity z employ] memb]s ( ! gr\p or   
association4  7c7 ,sub/antial bus9ess   
purpose  7#a7 ,9 g5]al ,= purposes (    
subsection 7b77#a71 a sub/antial bus9ess
 purpose %all exi/ if ! gr\p or         
association w\ld be a viable entity 9 ! 
abs5ce ( sponsor+ an employee b5efit    
plan4  7#b7 ,bus9ess purpose ,= purposes
 ( subsection 7b77#a7 & p>agraph 7#a71 a
 bus9ess purpose %all-- 7,a7 include    
promot+ common bus9ess int]e/s ( !      
memb]s ( ! gr\p or association or !     
common economic int]e/s 9 a giv5 trade  
or employ] community2 &  7,b7 n be      
requir$ to be a =-pr(it activity4  7d7  
,commonality ( int]e/  7#a7 ,9 g5]al    
,subject to p>agraph 7#c71 employ]      
memb]s ( ! gr\p or association %all be  

treat$ z hav+ a commonality ( int]e/ =  
purposes ( subsection 7b77#e7 if-- 7,a7 
! employ]s are 9 ! same trade1 indu/ry1 
l9e ( bus9ess1 or pr(ession2 or  7,b7   
ea* employ] has a pr9cipal place (      
bus9ess 9 ! same region t does n exce$ !
 b\nd>ies ( a s+le ,/ate or a           
metropolitan area 7ev5 if ! metropolitan
 area includes m ?an #a ,/ate74  7#b7   
,same trade1 indu/ry1 or l9e ( bus9ess  
,9 ! case ( a gr\p or association t is  
sponsor+ a gr\p heal? plan "u ?is       
section & t is itself an employ] memb] (
 ! gr\p or association1 ! gr\p or       
association %all be deem$ = purposes (  
p>agraph 7#a77;,a7 to be 9 ! same trade1
 indu/ry1 l9e ( bus9ess1 or pr(ession1 z
 applicable1 z ! o!r employ] memb]s ( ! 
gr\p or association4  7#c7              
,nondiscrim9ation ,! /&>ds "u p>agraph  
7#a7 %all n be implem5t$ 9 a mann] t is 
subt]fuge = discrim9ation z is prohibit$
 "u subsection 7e74  7e7                
,nondiscrim9ation  7#a7 ,9 g5]al ,a gr\p
 or association ( employ]s sponsor+ a   

gr\p heal? plan "u ?is section1 & any   
heal? cov]age sponsor$ by su* gr\p or   
association1 %all comply ) ea* ( !      
foll[+3 7,a7 ,! gr\p or association %all
 n condition employ] memb]%ip 9 ! gr\p  
or association on any heal? factor ( any
 individual :o is or may become eligible
 to p>ticipate 9 ! gr\p heal? plan      
sponsor$ by ! gr\p or association4  7,b7
 ,! gr\p heal? plan sponsor$ by ! gr\p  
or association %all comply ) ! rules "u 
section #beij4gjb7;b7 ( title #bi1 ,code
 ( ,f$]al ,regulations 7z 9 effect on   
,june #ba1 #bjah71 ) respect to         
nondiscrim9ation 9 rules = eligibility =
 b5efits1 subject to subp>agraph 7,d74  
7,c7 ,! gr\p heal? plan sponsor$ by !   
gr\p or association %all comply ) !     
rules "u section #beij4gjb7;c7 ( title  
#bi1 ,code ( ,f$]al ,regulations 7z 9   
effect on ,june #ba1 #bjah71 ) respect  
to nondiscrim9ation 9 premiums or       
contributions requir$ by any p>ticipant 
or b5efici>y = cov]age "u ! plan1       
subject to subp>agraph 7,d74  7,d7 ,9   

apply+ subp>agraphs 7,b7 & 7,c71 ! gr\p 
or association may n treat ! employees (
 diff]5t employ] memb]s ( ! gr\p or     
association z di/9ct gr\ps ( simil>ly   
situat$ individuals bas$ on a heal?     
factor ( #a or m individuals4  7#b7     
,def9ition ( heal? factor ,= purposes ( 
?is subsection1 ! t]m heal? factor has !
 mean+ giv5 su* t]m 9 section           
#beij4gjb7;a7 ( title #bi1 ,code (      
,f$]al ,regulations 7z 9 effect on ,june
 #ba1 #bjah74  7f7 ,dual treatm5t (     
work+ own]s z employ]s & employees  7#a7
 ,9 g5]al ,a p]son det]m9$ 9 accordance 
) p>agraph 7#b7 to be a work+ own] ( a  
trade or bus9ess may qualify z bo? an   
employ] & z an employee ( ! trade or    
bus9ess = purposes ( ! requirem5ts "u   
subsection 7b71 includ+ ! requirem5ts "u
 p>agraphs 7#b7 & 7#f7 ( su* subsection4
  7#b7 ,work+ own]  7,a7 ,eligibility ,a
 p]son %all qualify z a work+ own] if a 
responsible fiduci>y ( ! gr\p heal? plan
 reasonably det]m9es t ! p]son-- 7i7    
does n h any common law employees2  7ii7

 has an own]%ip "r ( any nature 9 a     
trade or bus9ess1 :e!r incorporat$ or   
un9corporat$1 includ+ a p>tn] & o!r     
self-employ$ individual2  7iii7 is e>n+ 
wages or self-employm5t income f ! trade
 or bus9ess = provid+ p]sonal s]vices to
 ! trade or bus9ess2 &  7iv7 ei!r-- 7,i7
 works on av]age at lea/ #bj h\rs p]    
week1 or at lea/ #hj h\rs p] mon?1      
provid+ p]sonal s]vices to ! p]son's    
trade or bus9ess1 or  7,,ii7 has wages  
or self-employm5t income f su* trade or 
bus9ess t at lea/ equals ! p]son's co/ (
 cov]age = p>ticipation by ! p]son1 &   
any cov]$ b5efici>ies1 9 ! gr\p heal?   
plan sponsor$ by ! gr\p or association 9
 :i* ! p]son is p>ticipat+4  7,b7       
,det]m9ation ,! det]m9ation "u          
subp>agraph 7,a7 %all be made :5 ! p]son
 fir/ becomes eligible = cov]age "u !   
gr\p heal? plan4  7,c7 ,reasonable      
monitor+ proc$ures ,a responsible       
fiduci>y ( ! gr\p heal? plan %all1 ?r\gh
 reasonable monitor+ proc$ures1         
p]iodically confirm ! cont9u$           

eligibility ( a p]son to qualify z a    
work+ own] "u subp>agraph 7,a7 =        
purposes ( meet+ ! requirem5ts "u       
subsection 7b7 = ! gr\p heal? plan      
sponsor$ "u ?is section4  7g7           
,applicability  7#a7 ,fully insur$ ,?is 
section %all apply beg9n+ on ,septemb]  
#a1 #bjba1 ) respect to a gr\p or       
association ( employ]s sponsor+ a gr\p  
heal? plan t is fully insur$4  7#b7     
,plans exp&+ to include broad] gr\p ,?is
 section %all apply beg9n+ on ,janu>y   
#a1 #bjbb1 ) respect to a gr\p or       
association ( employ]s sponsor+ a gr\p  
heal? plan t-- 7,a7 is n fully insur$2  
7,b7 is 9 exi/5ce on ,june #ba1 #bjah2  
7,c7 meets ! requirem5ts t appli$ )     
respect to su* plan be=e ,june #ba1     
#bjah2 &  7,d7 *ooses to be a plan      
sponsor$ "u ?is section 7& subject to ! 
requirem5ts "u subsections 7b7 ?r\gh    
7f774  7#c7 ,o!r association heal? plans
 ,?is section %all apply beg9n+ on      
,april #a1 #bjbb1 ) respect to any o!r  
gr\p or association ( employ]s sponsor+ 

a gr\p heal? plan4  7#d7 ,o!r crit]ia 9 
advisory op9ions ,! crit]ia "u ?is      
section %all n invalidate any crit]ia   
provid$ 9 an advisory op9ion1 9 effect  
on or aft] ! date ( enactm5t ( !        
,association ,heal? ,plans ,act ( #bjba1
 t ! ,secret>y may use to det]m9e if a  
gr\p or association ( employ]s is an    
employ] "u section #c7e7 = purposes (   
sponsor+ a gr\p heal? plan4  7h7        
,det]m9ation ( employ] or jo9t employ]  
/atus  7#a7 ,9 g5]al ,p>ticipat+ 9 or   
facilitat+ a gr\p heal? plan sponsor$ by
 a bona fide gr\p or association (      
employ]s pursuant to subsection 7a7 %all
 n be con/ru$ z e/abli%+ an employ] or  
jo9t employ] relation%ip "u any ,f$]al  
or ,/ate law4  7#b7 ,application (      
provision ,p>agraph 7#a7 %all apply to a
 gr\p heal? plan sponsor$ or facilitat$ 
by a fran*isor & any fran*isee1 by      
multiple fran*isors = ! b5efit ( !      
employees ( su* fran*isors & _!         
fran*isees1 by multiple fran*isees = !  
b5efit ( ! employees ( su* fran*isees1  

by a fran*isor ^: fran*isee or          
fran*isees p>ticipate or p>ticipates 9 !
 plan1 or by a p]son or entity t        
contracts ) any individual z an         
indep5d5t contractor = :om ! plan       
b5efits4  7i7 ,rule ( con/ruction ,no?+ 
9 ?is section %all be con/ru$ z repeal+ 
or o!rwise limit+ ! application ( ?is   
,act 7includ+ section #gab relat+ to    
m5tal heal? p>ity7 to gr\p heal? plans &
 employee welf>e b5efit plans4  4  7c7  
,cl]ical am5dm5t ,! table ( cont5ts 9   
section #a ( ! ,employee ,retirem5t     
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #ajja et seq47 is am5d$ by    
ins]t+ aft] ! item relat+ to section    
#gce ! foll[+ new item3  ,sec4 #gcf4    
,def9ition ( employ] ) respect to gr\p  
heal? plans4  4