#aahth ,,congress #ast ,session ,h4 ,r4 #cgii ,,an ,,act ,to amend the ,internal ,revenue ,code of #aihf to provide for health reimbursement arrangements integrated with individual health insurance coverage4 ,i ,association ,health ,plans ,act #aja4 ,short title ,this title may be cited as the ,association ,health ,plans ,act4 #ajb4 ,treatment of group or association of employers 7a7 ,in general ,section #c7e7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #ajjb7e77 is amended-- 7#a7 by striking ,the term and inserting 7,a7 ,the term2 and 7#b7 by adding at the end the following3 7,b7 ,for purposes of subparagraph 7,a71 a group or association of employers shall be treated as an employer1 regardless of whether the employers composing such group or association are in the same industry1 trade1 or profession1 if such group or association-- 7i7 7,i7 has established and maintains an employee welfare benefit plan that is a group health plan 7as defined in section #gcc7;a77#a772 7,,ii7 provides coverage under such plan to at least #ea employees after all of the employees employed by all of the employer members of such group or association have been aggregated and counted together as described in subparagraph 7,d72 7,,iii7 has been actively in existence for at least #b years prior to establishing and maintaining an employer welfare benefit plan that is a group health plan 7as defined in section #gcc7;a77#a772 7,,iv7 has been formed and maintained in good faith for purposes other than providing medical care 7as defined in section #gcc7;a77#b77 through the purchase of insurance or otherwise2 7,v7 does not condition membership in the group or association on any health status-related factor 7as described in section #gjb7;a77#a77 relating to any individual2 7,,vi7 makes coverage under such plan available to all employer members of such group or association regardless of any health status-related factor 7as described in section #gjb7;a77#a77 relating to such employer members2 7,,vii7 does not provide coverage under such plan to any individual other than an employee of an employer member of such group or association2 7,,viii7 has established a governing board with by-laws or other similar indications of formality to manage and operate such plan in both form and substance1 of which at least #ge percent of the board members shall be made up of employer members of such group or association participating in the plan that are duly elected by each participating employer member casting #a vote during a scheduled election2 7,,ix7 is not a health insurance issuer 7as defined in section #gcc7;b77#b771 and is not 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 a health insurance issuer-- 7aa7 may participate in the group or association as a member2 and 7bb7 may provide services such as assistance with plan development1 marketing1 and administrative services to such group or association2 7ii7 meets any set of criteria to qualify for such treatment in an advisory opinion issued by the ,secretary prior to the date of enactment of the ,association ,health ,plans ,act2 or 7iii7 meets any other set of criteria to qualify for such treatment that the ,secretary by regulation may provide4 7,c7 7i7 ,for purposes of subparagraph 7,b71 a self-employed individual shall be treated as-- 7,i7 an employer who may become a member of a group or association of employers2 7,,ii7 an employee who may participate in an employee welfare benefit plan established and maintained by such group or association2 and 7,,iii7 a participant of such plan subject to the eligibility determination and monitoring requirements set forth in clause 7iii74 7ii7 ,for purposes of this subparagraph1 the term self-employed individual means an individual who-- 7,i7 does not have any common law employees2 7,,ii7 has an ownership right in a trade or business1 regardless of whether such trade or business is incorporated or unincorporated2 7,,iii7 earns wages 7as defined in section #caba7;a7 of the ,internal ,revenue ,code of #aihf7 or self-employment income 7as defined in section #adjb7;b7 of such ,code7 from such trade or business2 and 7,,iv7 works at least #aj hours per week or #dj hours per month providing personal services to such trade or business4 7iii7 ,the board of a group or association of employers shall-- 7,i7 initially determine whether an individual meets the requirements under clause 7ii7 to be considered a self-employed individual for the purposes of being treated as an-- 7aa7 employer member of such group or association 7in accordance with clause 7i77,i772 and 7bb7 employee who may participate in the employee welfare benefit plan established and maintained by such group or association 7in accordance with clause 7i77,,ii772 7,,ii7 through reasonable monitoring procedures1 periodically determine whether the individual continues to meet such requirements2 and 7,,iii7 if the board determines that an individual no longer meets such requirements1 not make such plan coverage available to such individual 7or dependents thereof7 for any plan year following the plan year during which the board makes such determination4 ,if1 subsequent to a determination that an individual no longer meets such requirements1 such individual furnishes evidence of satisfying such requirements1 such individual 7and dependents thereof7 shall be eligible to receive plan coverage4 7,d7 ,for purposes of subparagraph 7,b71 all of the employees 7including self-employed individuals7 employed by all of the employer members 7including self-employed individuals7 of a group or association of employers shall be-- 7i7 treated as employed by a single employer2 and 7ii7 aggregated and counted together for purposes of any regulation of an employee welfare benefit plan established and maintained by such group or association4 4 7b7 ,determination of employer or joint employer status ,the provision of employee welfare benefit plan coverage by a group or association of employers shall not be construed as evidence for establishing an employer or joint employer relationship under any ,federal or ,state law4 #ajc4 ,rules applicable to group health plans established and maintained by a group or association of employers ,part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha1 et seq47 is amended by adding at the end the following3 #gcf4 ,rules applicable to group health plans established and maintained by a group or association of employers 7a7 ,premium rates for a group or association of employers 7#a7 7,a7 ,in the case of a group health plan established and maintained by a group or association of employers described in section #c7e77;,b71 such plan may-- 7i7 establish base premium rates formed on an actuarially sound1 modified community rating methodology that considers the pooling of all plan participant claims2 and 7ii7 utilize the specific risk profile of each employer member of such group or association to determine contribution rates for each such employer member's share of a premium by actuarially adjusting above or below the established base premium rates4 7,b7 ,for purposes of paragraph 7#a71 the term employer member means-- 7i7 an employer who is a member of such group or association of employers and employs at least #a common law employee2 or 7ii7 a group made up solely of self-employed individuals1 within which all of the self-employed individual members of such group or association are aggregated together as a single employer member group1 provided the group includes at least #bj self-employed individual members4 7#b7 ,in the event a group or association is made up solely of self-employed individuals 7and no employers with at least #a common law employee are members of such group or association71 the group health plan established by such group or association shall-- 7,a7 treat all self-employed individuals who are members of such group or association as a single risk pool2 7,b7 pool all plan participant claims2 and 7,c7 charge each plan participant the same premium rate4 7b7 ,discrimination and pre-existing condition protections ,a group health plan established and maintained by a group or association of employers described in section #c7e77;,b7 shall be prohibited from-- 7#a7 establishing any rule for eligibility 7including continued eligibility7 of any individual 7including an employee of an employer member or a self-employed individual1 or a dependent of such employee or self-employed individual7 to enroll for benefits under the terms of the plan that discriminates based on any health status-related factor that relates to such individual 7consistent with the rules under section #gjb7;a77#a772 7#b7 requiring an individual 7including an employee of an employer member or a self-employed individual1 or a dependent of such employee or self-employed individual71 as a condition of enrollment or continued enrollment under the plan1 to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan based on any health status-related factor that relates to such individual 7consistent with the rules under section #gjb7;b77#a772 and 7#c7 denying coverage under such plan on the basis of a pre-existing condition 7consistent with the rules under section #bgjd of the ,public ,health ,service ,act74 4 #ajd4 ,rule of construction ,nothing in this title shall be construed to exempt a group health plan which is an employee welfare benefit plan offered through a group or association of employers from the requirements of part #g of subtitle ,b of title ,i of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaha et4 seq471 including the provisions of part ,a of title ,,xxvii of the ,public ,health ,service ,act as incorporated by reference into this ,act through section #gae4 ,,ii ,,choice ,arrangement ,act #bja4 ,short title ,this title may be cited as the ,custom ,health ,option and ,individual ,care ,expense ,arrangement ,act or the ,,choice ,arrangement ,act4 #bjb4 ,treatment of health reimbursement arrangements integrated with individual market coverage 7a7 ,in general ,section #ihae7;b7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by striking ,exception4--,notwithstanding subsection 7a7 and inserting the following3 ,exceptions4-- 7#a7 ,self-insured group health plans ,notwithstanding subsection 7a7 1 and 7#b7 by adding at the end the following new paragraph3 7#b7 ,custom health option and individual care expense arrangements 7,a7 ,in general ,for purposes of this subchapter1 a custom health option and individual care expense arrangement shall be treated as meeting the requirements of sections #bgaa and #bgac of title ,,xxvii of the ,public ,health ,service ,act4 7,b7 ,custom health option and individual care expense arrangements defined ,for purposes of this section1 the term custom health option and individual care expense arrangement means a health reimbursement arrangement-- 7i7 which is an employer-provided group health plan funded solely by employer contributions to provide payments or reimbursements for medical care subject to a maximum fixed dollar amount for a period1 7ii7 under which such payments or reimbursements may only be made for medical care provided during periods during which the individual is covered-- 7,i7 under individual health insurance coverage 7other than coverage that consists solely of excepted benefits71 or 7,,ii7 under part ,a and ,b of title ,,xviii of the ,social ,security ,act or part ,c of such title1 7iii7 which meets the nondiscrimination requirements of subparagraph 7,c71 7iv7 which meets the substantiation requirements of subparagraph 7,d71 and 7v7 which meets the notice requirements of subparagraph 7,e74 7,c7 ,nondiscrimination 7i7 ,in general ,an arrangement meets the requirements of this subparagraph if an employer offering such arrangement to an employee within a specified class of employee-- 7,i7 offers such arrangement to all employees within such specified class on the same terms1 and 7,,ii7 does not offer any other group health plan to any employees within such specified class4 7ii7 ,specified class of employee ,for purposes of this subparagraph1 any of the following may be designated as a specified class of employee3 7,i7 ,full-time employees4 7,,ii7 ,part-time employees4 7,,iii7 ,salaried employees4 7,,iv7 ,non-salaried employees4 7,v7 ,employees whose primary site of employment is in the same rating area4 7,,vi7 ,employees who are included in a unit of employees covered under a collective bargaining agreement to which the employer is subject 7determined under rules similar to the rules of section #aje7;h774 7,,vii7 ,employees who have not met a group health plan1 or health insurance issuer offering group health insurance coverage1 waiting period requirement that satisfies the of section #bgjh of the ,public ,health ,service ,act4 7,,viii7 ,seasonal employees4 7,,ix7 ,employees who are nonresident aliens and who receive no earned income 7within the meaning of section #iaa7;d77#b77 from the employer which constitutes income from sources within the ,united ,states 7within the meaning of section #hfa7;a77#c774 7,x7 ,such other classes of employees as the ,secretary may designate4 ,an employer may designate 7in such manner as is prescribed by the ,secretary7 two or more of the classes described in the preceding subclauses as the specified class of employees to which the arrangement is offered for purposes of applying this subparagraph4 7iii7 ,special rule for new hires ,an employer may designate prospectively so much of a specified class of employees as are hired after a date set by the employer4 ,such subclass of employees shall be treated as the specified class for purposes of applying clause 7i74 7iv7 ,rules for determining type of employee ,for purposes for clause 7ii71 any determination of full-time1 part-time1 or seasonal employment status shall be made under rules similar to the rules of section #aje7;h7 or #dihj;,h1 whichever the employer elects for the plan year4 ,such election shall apply with respect to all employees of the employer for the plan year4 7v7 ,permitted variation ,for purposes of clause 7i77,i71 an arrangement shall not fail to be treated as provided on the same terms within a specified class merely because the maximum dollar amount of payments and reimbursements which may be made under the terms of the arrangement for the year with respect to each employee within such class-- 7,i7 increases as additional dependents of the employee are covered under the arrangement1 and 7,,ii7 increases with respect to a participant as the age of the participant increases1 but not in excess of an amount equal to #cjj percent the lowest maximum dollar amount with respect to such a participant determined without regard to age4 7,d7 ,substantiation requirements ,an arrangement meets the requirements of this subparagraph if the arrangement has reasonable procedures to substantiate-- 7i7 that the participant is1 or will be1 enrolled in coverage described in subparagraph 7,b77ii7 as of the beginning of the plan year of the arrangement 7or as of the beginning of coverage under the arrangement in the case of an employee who first becomes eligible to participate in the arrangement after the date notice is given with respect to the plan under subparagraph 7,e7 7determined without regard to clause 7iii7 thereof71 and 7ii7 any requests made for payment or reimbursement of medical care under the arrangement and that the participant remains so enrolled4 7,e7 ,notice 7i7 ,in general ,except as provided in clause 7iii71 an arrangement meets the requirements of this subparagraph if1 under the arrangement1 each employee eligible to participate is1 not later than #ij days before the beginning of the plan year1 given written notice of the employee's rights and obligations under the arrangement which-- 7,i7 is sufficiently accurate and comprehensive to appraise the employee of such rights and obligations1 and 7,,ii7 is written in a manner calculated to be understood by the average employee eligible to participate4 7ii7 ,notice requirements ,such notice shall include such information as the ,secretary may by regulation prescribe4 7iii7 ,notice deadline for certain employees ,in the case of an employee-- 7,i7 who first becomes eligible to participate in the arrangement after the date notice is given with respect to the plan under clause 7i7 7determined without regard to this clause71 or 7,,ii7 whose employer is first established fewer than #abj days before the beginning of the first plan year of the arrangement1 the requirements of this subparagraph shall be treated as met if the notice required under clause 7i7 is provided not later than the date the arrangement may take effect with respect to such employee4 4 7b7 ,no inference ,to the extent not inconsistent with the amendments made by this section-- 7#a7 no inference shall be made from such amendments with respect to the rules prescribed in the ,federal ,register on ,june #bj1 #bjai1 7#hd ,fed4 ,reg4 #bhhhh7 relating to health reimbursement arrangements and other account-based group health plans1 and 7#b7 any reference to custom health option and individual care expense arrangements shall for purposes of such rules be treated as including a reference to individual coverage health reimbursement arrangements4 7c7 ,effective date ,the amendments made by this section shall apply to plan years beginning after ,december #ca1 #bjbc4 ,,iii ,self-,insurance ,protection ,act #cja4 ,short title ,this title may be cited as the ,self-,insurance ,protection ,act4 #cjb4 ,findings ,congress finds the following3 7#a7 ,small and large employers offer health benefit plan coverage to employees in self-funded arrangements using company assets or a fund1 or by paying premiums to purchase fully-insured coverage from a health insurance company4 7#b7 ,employers that self-fund health benefit plans will often purchase stop-loss insurance as a financial risk management tool to protect against excess or unexpected catastrophic health plan claims losses that arise above projected costs paid out of company assets4 7#c7 ,stop-loss coverage insures the employer sponsoring the health benefit plan against unforeseen health plan claims1 does not insure the employee health benefit plan itself1 and does not pay health care providers for medical services provided to the employees4 7#d7 ,employer-sponsored health benefit plans are regulated under the ,employee ,retirement ,income ,security ,act of #aigd1 however1 ,states regulate the availability and the coverage terms of stop-loss insurance coverage that employers purchase to protect company assets and to protect a fund against excess or unexpected claims losses4 7#e7 ,both large and small employers that choose to self-fund must also be able to protect company assets or a fund against excess or unexpected claims losses and ,states must reasonably regulate stop-loss insurance to assure its availability to both large and small employers4 #cjc4 ,certain medical stop-loss insurance obtained by certain plan sponsors of group health plans not included under the definition of health insurance coverage ,section #gcc7;b77#a7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aaia;b7b77#a77 is amended by adding at the end the following sentence3 ,such term shall not include a stop-loss policy obtained by a self-insured group health plan or a plan sponsor of a group health plan that self-insures the health risks of its plan participants to reimburse the plan or sponsor for losses that the plan or sponsor incurs in providing health or medical benefits to such plan participants in excess of a predetermined level set forth in the stop-loss policy obtained by such plan or sponsor44 #cjd4 ,effect on other laws ,section #ead7;b7 of the ,employee ,retirement ,income ,security ,act of #aigd 7#bi ,u4,s4,c4 #aadd7;b77 is amended by adding at the end the following3 7#aj7 ,the provisions of this title 7including part #g relating to group health plans7 shall preempt ,state laws insofar as they may now or hereafter prevent an employee benefit plan that is a group health plan from insuring against the risk of excess or unexpected health plan claims losses4 4 ,,iv ,small ,business ,flexibility ,act #dja4 ,short title ,this title may be cited as the ,small ,business ,flexibility ,act4 #djb4 ,notification of flexible health insurance benefits 7a7 ,in general ,subchapter ,c of chapter #ajj of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new section3 #ihce4 ,notification of flexible health insurance benefits 7a7 ,in general ,not later than #a year after the date of enactment of this section1 the ,secretary shall notify employers of the availability of tax-advantaged flexible health insurance benefits1 with an initial focus on small businesses1 particularly in rural areas 7as defined in section #acic7;a77#b774 7b7 ,definitions ,in this section3 7#a7 ,employer ,the term employer has the meaning given such term in section #c7e7 of the ,employee ,retirement ,income ,security ,act 7#bi ,u4,s4,c4 #ajjb7e774 7#b7 ,flexible health insurance benefits ,the term flexible health insurance benefits means-- 7,a7 an individual contribution health reimbursement arrangement 7as described in the rule entitled ,health ,reimbursement ,arrangements and ,other ,account-,based ,group ,health ,plans 7#hd ,fed4 ,reg4 #bhhhh 7,june #bj1 #bjai772 7,b7 a qualified small employer health reimbursement arrangement 7as defined in section #ihca7;d77#b772 and 7,c7 the small employer health insurance credit determined under section #de,r4 4 7b7 ,clerical amendment ,the table of sections for subchapter ,c of chapter #ajj of such ,code is amended by adding at the end the following new item3 ,sec4 #ihce4 ,notification of flexible health insurance benefits4 4 ,v ,rescissions #eja4 ,prevention and ,public ,health ,fund ,section #djjb7;b77#g7 of the ,patient ,protection and ,affordable ,care ,act 7#db ,u4,s4,c4 #cjju-#aa7;b77#g77 is amended by striking for each of fiscal years #bjbd and #bjbe1 #a1cjj1jjj1jjj and inserting for fiscal year #bjbd1 #a1jee1jjj1jjj1 and for fiscal year #bjbe1 #a1cjj1jjj1jjj4 ,,vi ,sense of ,congress that ,americans shall have healthcare freedom #fja4 ,sense of ,congress that healthcare freedom is the future ,it is the sense of ,congress that-- 7#a7 the future of healthcare lies in healthcare freedom1 not in socialized medicine2 7#b7 ,congress should take steps to address the broken healthcare system by restoring free market practices to lower costs2 7#c7 coverage is not care1 and expanding direct access to healthcare should be prioritized over expanding access to coverage2 and 7#d7 patients and doctors1 not government bureaucrats or insurance bureaucrats1 should make healthcare decisions4 ,passed the ,house of ,representatives ,june #ba1 #bjbc4;,clerk4