#aah? ,,congress  #a/ ,session  ,h4 ,r4 
#cgii  ,,an ,,act  ,to am5d ! ,int]nal  
,rev5ue ,code ( #aihf to provide = heal?
 reimbursem5t arrangem5ts integrat$ )   
individual heal? insurance cov]age4  ,i 
,association ,heal? ,plans ,act  #aja4  
,%ort title ,?is title may be cit$ z !  
,association ,heal? ,plans ,act4  #ajb4 
,treatm5t ( gr\p or association (       
employ]s  7a7 ,9 g5]al ,section #c7e7 ( 
! ,employee ,retirem5t ,income ,security
 ,act ( #aigd 7#bi ,u4,s4,c4 #ajjb7e77  
is am5d$--  7#a7 by /rik+ ,! t]m &      
ins]t+ 7,a7 ,! t]m2 &  7#b7 by add+ at !
 end ! foll[+3  7,b7 ,= purposes (      
subp>agraph 7,a71 a gr\p or association 
( employ]s %all be treat$ z an employ]1 
reg>dless ( :e!r ! employ]s compos+ su* 
gr\p or association are 9 ! same        
indu/ry1 trade1 or pr(ession1 if su*    
gr\p or association-- 7i7 7,i7 has      
e/abli%$ & ma9ta9s an employee welf>e   
b5efit plan t is a gr\p heal? plan 7z   
def9$ 9 section #gcc7;a77#a772  7,,ii7  
provides cov]age "u su* plan to at lea/ 

#ea employees aft] all ( ! employees    
employ$ by all ( ! employ] memb]s ( su* 
gr\p or association h be5 aggregat$ &   
c\nt$ toge!r z describ$ 9 subp>agraph   
7,d72  7,,iii7 has be5 actively 9       
exi/5ce = at lea/ #b ye>s prior to      
e/abli%+ & ma9ta9+ an employ] welf>e    
b5efit plan t is a gr\p heal? plan 7z   
def9$ 9 section #gcc7;a77#a772  7,,iv7  
has be5 =m$ & ma9ta9$ 9 good fai? =     
purposes o!r ?an provid+ m$ical c>e 7z  
def9$ 9 section #gcc7;a77#b77 ?r\gh !   
pur*ase ( insurance or o!rwise2  7,v7   
does n condition memb]%ip 9 ! gr\p or   
association on any heal? /atus-relat$   
factor 7z describ$ 9 section            
#gjb7;a77#a77 relat+ to any individual2 
7,,vi7 makes cov]age "u su* plan        
available to all employ] memb]s ( su*   
gr\p or association reg>dless ( any     
heal? /atus-relat$ factor 7z describ$ 9 
section #gjb7;a77#a77 relat+ to su*     
employ] memb]s2  7,,vii7 does n provide 
cov]age "u su* plan to any individual   
o!r ?an an employee ( an employ] memb] (

 su* gr\p or association2  7,,viii7 has 
e/abli%$ a gov]n+ bo>d ) by-laws or o!r 
simil> indications ( =mality to manage &
 op]ate su* plan 9 bo? =m & sub/ance1 ( 
:i* at lea/ #ge p]c5t ( ! bo>d memb]s   
%all be made up ( employ] memb]s ( su*  
gr\p or association p>ticipat+ 9 ! plan 
t are duly elect$ by ea* p>ticipat+     
employ] memb] ca/+ #a vote dur+ a s*$ul$
 election2  7,,ix7 is n a heal?         
insurance issu] 7z def9$ 9 section      
#gcc7;b77#b771 & is n 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* 
a heal? insurance issu]--  7aa7 may     
p>ticipate 9 ! gr\p or association z a  
memb]2 &  7bb7 may provide s]vices su* z
 assi/ance ) plan developm5t1 m>ket+1 & 
adm9i/rative s]vices to su* gr\p or     
association2  7ii7 meets any set (      
crit]ia to qualify = su* treatm5t 9 an  
advisory op9ion issu$ by ! ,secret>y    
prior to ! date ( enactm5t ( !          
,association ,heal? ,plans ,act2 or     

7iii7 meets any o!r set ( crit]ia to    
qualify = su* treatm5t t ! ,secret>y by 
regulation may provide4  7,c7  7i7 ,=   
purposes ( subp>agraph 7,b71 a          
self-employ$ individual %all be treat$  
z-- 7,i7 an employ] :o may become a     
memb] ( a gr\p or association (         
employ]s2  7,,ii7 an employee :o may    
p>ticipate 9 an employee welf>e b5efit  
plan e/abli%$ & ma9ta9$ by su* gr\p or  
association2 &  7,,iii7 a p>ticipant (  
su* plan subject to ! eligibility       
det]m9ation & monitor+ requirem5ts set  
=? 9 clause 7iii74  7ii7 ,= purposes (  
?is subp>agraph1 ! t]m self-employ$     
individual means an individual :o-- 7,i7
 does n h any common law employees2     
7,,ii7 has an own]%ip "r 9 a trade or   
bus9ess1 reg>dless ( :e!r su* trade or  
bus9ess is incorporat$ or un9corporat$2 
7,,iii7 e>ns wages 7z def9$ 9 section   
#caba7;a7 ( ! ,int]nal ,rev5ue ,code (  
#aihf7 or self-employm5t income 7z def9$
 9 section #adjb7;b7 ( su* ,code7 f su* 
trade or bus9ess2 &  7,,iv7 works at    

lea/ #aj h\rs p] week or #dj h\rs p]    
mon? provid+ p]sonal s]vices to su*     
trade or bus9ess4  7iii7 ,! bo>d ( a    
gr\p or association ( employ]s %all--   
7,i7 initially det]m9e :e!r an          
individual meets ! requirem5ts "u clause
 7ii7 to be consid]$ a self-employ$     
individual = ! purposes ( be+ treat$ z  
an-- 7aa7 employ] memb] ( su* gr\p or   
association 79 accordance ) clause      
7i77,i772 &  7bb7 employee :o may       
p>ticipate 9 ! employee welf>e b5efit   
plan e/abli%$ & ma9ta9$ by su* gr\p or  
association 79 accordance ) clause      
7i77,,ii772  7,,ii7 ?r\gh reasonable    
monitor+ proc$ures1 p]iodically det]m9e 
:e!r ! individual cont9ues to meet su*  
requirem5ts2 &  7,,iii7 if ! bo>d       
det]m9es t an individual no long] meets 
su* requirem5ts1 n make su* plan cov]age
 available to su* individual 7or        
dep5d5ts !re(7 = any plan ye> foll[+ !  
plan ye> dur+ :i* ! bo>d makes su*      
det]m9ation4 ,if1 subsequ5t to a        
det]m9ation t an individual no long]    

meets su* requirem5ts1 su* individual   
furni%es evid5ce ( satisfy+ su*         
requirem5ts1 su* individual 7& dep5d5ts 
!re(7 %all be eligible to receive plan  
cov]age4  7,d7 ,= purposes ( subp>agraph
 7,b71 all ( ! employees 7includ+       
self-employ$ individuals7 employ$ by all
 ( ! employ] memb]s 7includ+            
self-employ$ individuals7 ( a gr\p or   
association ( employ]s %all be--  7i7   
treat$ z employ$ by a s+le employ]2 &   
7ii7 aggregat$ & c\nt$ toge!r = purposes
 ( any regulation ( an employee welf>e  
b5efit plan e/abli%$ & ma9ta9$ by su*   
gr\p or association4  4  7b7            
,det]m9ation ( employ] or jo9t employ]  
/atus ,! provision ( employee welf>e    
b5efit plan cov]age by a gr\p or        
association ( employ]s %all n be con/ru$
 z evid5ce = e/abli%+ an employ] or jo9t
 employ] relation%ip "u any ,f$]al or   
,/ate law4  #ajc4 ,rules applicable to  
gr\p heal? plans e/abli%$ & ma9ta9$ by a
 gr\p or association ( employ]s ,"p #g (
 subtitle ,b ( title ,i ( ! ,employee   

,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aaha1 et seq47 is 
am5d$ by add+ at ! end ! foll[+3  #gcf4 
,rules applicable to gr\p heal? plans   
e/abli%$ & ma9ta9$ by a gr\p or         
association ( employ]s  7a7 ,premium    
rates = a gr\p or association ( employ]s
  7#a7  7,a7 ,9 ! case ( a gr\p heal?   
plan e/abli%$ & ma9ta9$ by a gr\p or    
association ( employ]s describ$ 9       
section #c7e77;,b71 su* plan may-- 7i7  
e/abli% base premium rates =m$ on an    
actu>ially s\nd1 modifi$ community rat+ 
me?odology t consid]s ! pool+ ( all plan
 p>ticipant claims2 &  7ii7 utilize !   
specific risk pr(ile ( ea* employ] memb]
 ( su* gr\p or association to det]m9e   
contribution rates = ea* su* employ]    
memb]'s %>e ( a premium by actu>ially   
adju/+ above or bel[ ! e/abli%$ base    
premium rates4  7,b7 ,= purposes (      
p>agraph 7#a71 ! t]m employ] memb]      
means--  7i7 an employ] :o is a memb] ( 
su* gr\p or association ( employ]s &    
employs at lea/ #a common law employee2 

or  7ii7 a gr\p made up solely (        
self-employ$ individuals1 )9 :i* all ( !
 self-employ$ individual memb]s ( su*   
gr\p or association are aggregat$ toge!r
 z a s+le employ] memb] gr\p1 provid$ ! 
gr\p includes at lea/ #bj self-employ$  
individual memb]s4  7#b7 ,9 ! ev5t a    
gr\p or association is made up solely ( 
self-employ$ individuals 7& no employ]s 
) at lea/ #a common law employee are    
memb]s ( su* gr\p or association71 !    
gr\p heal? plan e/abli%$ by su* gr\p or 
association %all-- 7,a7 treat all       
self-employ$ individuals :o are memb]s (
 su* gr\p or association z a s+le risk  
pool2  7,b7 pool all plan p>ticipant    
claims2 &  7,c7 *>ge ea* plan p>ticipant
 ! same premium rate4  7b7              
,discrim9ation & pre-exi/+ condition    
protections ,a gr\p heal? plan e/abli%$ 
& ma9ta9$ by a gr\p or association (    
employ]s describ$ 9 section #c7e77;,b7  
%all be prohibit$ f-- 7#a7 e/abli%+ any 
rule = eligibility 7includ+ cont9u$     
eligibility7 ( any individual 7includ+  

an employee ( an employ] memb] or a     
self-employ$ individual1 or a dep5d5t ( 
su* employee or self-employ$ individual7
 to enroll = b5efits "u ! t]ms ( ! plan 
t discrim9ates bas$ on any heal?        
/atus-relat$ factor t relates to su*    
individual 7consi/5t ) ! rules "u       
section #gjb7;a77#a772  7#b7 requir+ an 
individual 7includ+ an employee ( an    
employ] memb] or a self-employ$         
individual1 or a dep5d5t ( su* employee 
or self-employ$ individual71 z a        
condition ( enrollm5t or cont9u$        
enrollm5t "u ! plan1 to pay a premium or
 contribution t is great] ?an ! premium 
or contribution = a simil>ly situat$    
individual enroll$ 9 ! plan bas$ on any 
heal? /atus-relat$ factor t relates to  
su* individual 7consi/5t ) ! rules "u   
section #gjb7;b77#a772 &  7#c7 d5y+     
cov]age "u su* plan on ! basis ( a      
pre-exi/+ condition 7consi/5t ) ! rules 
"u section #bgjd ( ! ,public ,heal?     
,s]vice ,act74  4  #ajd4 ,rule (        
con/ruction ,no?+ 9 ?is title %all be   

con/ru$ to exempt a gr\p heal? plan :i* 
is an employee welf>e b5efit plan (f]$  
?r\gh a gr\p or association ( employ]s f
 ! requirem5ts ( "p #g ( subtitle ,b (  
title ,i ( ! ,employee ,retirem5t       
,income ,security ,act ( #aigd 7#bi     
,u4,s4,c4 #aaha et4 seq471 includ+ !    
provisions ( "p ,a ( title ,,xxvii ( !  
,public ,heal? ,s]vice ,act z           
incorporat$ by ref]5ce into ?is ,act    
?r\gh section #gae4  ,,ii ,,*oice       
,arrangem5t ,act  #bja4 ,%ort title ,?is
 title may be cit$ z ! ,cu/om ,heal?    
,option & ,individual ,c>e ,exp5se      
,arrangem5t ,act or ! ,,*oice           
,arrangem5t ,act4  #bjb4 ,treatm5t (    
heal? reimbursem5t arrangem5ts integrat$
 ) individual m>ket cov]age  7a7 ,9     
g5]al ,section #ihae7;b7 ( ! ,int]nal   
,rev5ue ,code ( #aihf is am5d$-- 7#a7 by
 /rik+ ,exception4--,not)/&+ subsection 
7a7 & ins]t+ ! foll[+3  ,exceptions4--  
7#a7 ,self-insur$ gr\p heal? plans      
,not)/&+ subsection 7a7  1 &  7#b7 by   
add+ at ! end ! foll[+ new p>agraph3    

7#b7 ,cu/om heal? option & individual   
c>e exp5se arrangem5ts  7,a7 ,9 g5]al ,=
 purposes ( ?is sub*apt]1 a cu/om heal? 
option & individual c>e exp5se          
arrangem5t %all be treat$ z meet+ !     
requirem5ts ( sections #bgaa & #bgac (  
title ,,xxvii ( ! ,public ,heal? ,s]vice
 ,act4  7,b7 ,cu/om heal? option &      
individual c>e exp5se arrangem5ts def9$ 
,= purposes ( ?is section1 ! t]m cu/om  
heal? option & individual c>e exp5se    
arrangem5t means a heal? reimbursem5t   
arrangem5t-- 7i7 :i* is an              
employ]-provid$ gr\p heal? plan fund$   
solely by employ] contributions to      
provide paym5ts or reimbursem5ts =      
m$ical c>e subject to a maximum fix$    
doll> am\nt = a p]iod1  7ii7 "u :i* su* 
paym5ts or reimbursem5ts may only be    
made = m$ical c>e provid$ dur+ p]iods   
dur+ :i* ! individual is cov]$-- 7,i7 "u
 individual heal? insurance cov]age 7o!r
 ?an cov]age t consi/s solely ( except$ 
b5efits71 or  7,,ii7 "u "p ,a & ,b (    
title ,,xviii ( ! ,social ,security ,act

 or "p ,c ( su* title1  7iii7 :i* meets 
! nondiscrim9ation requirem5ts (        
subp>agraph 7,c71  7iv7 :i* meets !     
sub/antiation requirem5ts ( subp>agraph 
7,d71 &  7v7 :i* meets ! notice         
requirem5ts ( subp>agraph 7,e74  7,c7   
,nondiscrim9ation  7i7 ,9 g5]al ,an     
arrangem5t meets ! requirem5ts ( ?is    
subp>agraph if an employ] (f]+ su*      
arrangem5t to an employee )9 a specifi$ 
class ( employee-- 7,i7 (f]s su*        
arrangem5t to all employees )9 su*      
specifi$ class on ! same t]ms1 &  7,,ii7
 does n (f] any o!r gr\p heal? plan to  
any employees )9 su* specifi$ class4    
7ii7 ,specifi$ class ( employee ,=      
purposes ( ?is subp>agraph1 any ( !     
foll[+ may be designat$ z a specifi$    
class ( employee3  7,i7 ,full-"t        
employees4  7,,ii7 ,"p-"t employees4    
7,,iii7 ,sal>i$ employees4  7,,iv7      
,non-sal>i$ employees4  7,v7 ,employees 
^: prim>y site ( employm5t is 9 ! same  
rat+ area4  7,,vi7 ,employees :o are    
includ$ 9 a unit ( employees cov]$ "u a 

collective b>ga9+ agreem5t to :i* !     
employ] is subject 7det]m9$ "u rules    
simil> to ! rules ( section #aje7;h774  
7,,vii7 ,employees :o h n met a gr\p    
heal? plan1 or heal? insurance issu]    
(f]+ gr\p heal? insurance cov]age1 wait+
 p]iod requirem5t t satisfies ! (       
section #bgjh ( ! ,public ,heal? ,s]vice
 ,act4  7,,viii7 ,seasonal employees4   
7,,ix7 ,employees :o are nonresid5t     
ali5s & :o receive no e>n$ income 7)9 ! 
mean+ ( section #iaa7;d77#b77 f !       
employ] :i* con/itutes income f s\rces  
)9 ! ,unit$ ,/ates 7)9 ! mean+ ( section
 #hfa7;a77#c774  7,x7 ,su* o!r classes (
 employees z ! ,secret>y may designate4 
,an employ] may designate 79 su* mann] z
 is prescrib$ by ! ,secret>y7 two or m (
 ! classes describ$ 9 ! prec$+          
subclauses z ! specifi$ class (         
employees to :i* ! arrangem5t is (f]$ = 
purposes ( apply+ ?is subp>agraph4      
7iii7 ,special rule = new hires ,an     
employ] may designate prospectively s   
mu* ( a specifi$ class ( employees z are

 hir$ aft] a date set by ! employ]4 ,su*
 subclass ( employees %all be treat$ z !
 specifi$ class = purposes ( apply+     
clause 7i74  7iv7 ,rules = det]m9+ type 
( employee ,= purposes = clause 7ii71   
any det]m9ation ( full-"t1 "p-"t1 or    
seasonal employm5t /atus %all be made "u
 rules simil> to ! rules ( section      
#aje7;h7 or #dihj;,h1 :i*ev] ! employ]  
elects = ! plan ye>4 ,su* election %all 
apply ) respect to all employees ( !    
employ] = ! plan ye>4  7v7 ,p]mitt$     
v>iation ,= purposes ( clause 7i77,i71  
an arrangem5t %all n fail to be treat$ z
 provid$ on ! same t]ms )9 a specifi$   
class m]ely because ! maximum doll>     
am\nt ( paym5ts & reimbursem5ts :i* may 
be made "u ! t]ms ( ! arrangem5t = ! ye>
 ) respect to ea* employee )9 su*       
class-- 7,i7 increases z additional     
dep5d5ts ( ! employee are cov]$ "u !    
arrangem5t1 &  7,,ii7 increases )       
respect to a p>ticipant z ! age ( !     
p>ticipant increases1 b n 9 excess ( an 
am\nt equal to #cjj p]c5t ! l[e/ maximum

 doll> am\nt ) respect to su* a         
p>ticipant det]m9$ )\t reg>d to age4    
7,d7 ,sub/antiation requirem5ts ,an     
arrangem5t meets ! requirem5ts ( ?is    
subp>agraph if ! arrangem5t has         
reasonable proc$ures to sub/antiate--   
7i7 t ! p>ticipant is1 or w be1 enroll$ 
9 cov]age describ$ 9 subp>agraph        
7,b77ii7 z ( ! beg9n+ ( ! plan ye> ( !  
arrangem5t 7or z ( ! beg9n+ ( cov]age "u
 ! arrangem5t 9 ! case ( an employee :o 
fir/ becomes eligible to p>ticipate 9 ! 
arrangem5t aft] ! date notice is giv5 ) 
respect to ! plan "u subp>agraph 7,e7   
7det]m9$ )\t reg>d to clause 7iii7      
!re(71 &  7ii7 any reque/s made = paym5t
 or reimbursem5t ( m$ical c>e "u !      
arrangem5t & t ! p>ticipant rema9s s    
enroll$4  7,e7 ,notice  7i7 ,9 g5]al    
,except z provid$ 9 clause 7iii71 an    
arrangem5t meets ! requirem5ts ( ?is    
subp>agraph if1 "u ! arrangem5t1 ea*    
employee eligible to p>ticipate is1 n   
lat] ?an #ij days be=e ! beg9n+ ( ! plan
 ye>1 giv5 writt5 notice ( ! employee's 

rights & obligations "u ! arrangem5t    
:i*-- 7,i7 is suffici5tly accurate &    
compreh5sive to appraise ! employee (   
su* rights & obligations1 &  7,,ii7 is  
writt5 9 a mann] calculat$ to be        
und]/ood by ! av]age employee eligible  
to p>ticipate4  7ii7 ,notice requirem5ts
 ,su* notice %all include su* in=mation 
z ! ,secret>y may by regulation         
prescribe4  7iii7 ,notice deadl9e =     
c]ta9 employees ,9 ! case ( an          
employee-- 7,i7 :o fir/ becomes eligible
 to p>ticipate 9 ! arrangem5t aft] !    
date notice is giv5 ) respect to ! plan 
"u clause 7i7 7det]m9$ )\t reg>d to ?is 
clause71 or  7,,ii7 ^: employ] is fir/  
e/abli%$ few] ?an #abj days be=e !      
beg9n+ ( ! fir/ plan ye> ( ! arrangem5t1
  ! requirem5ts ( ?is subp>agraph %all  
be treat$ z met if ! notice requir$ "u  
clause 7i7 is provid$ n lat] ?an ! date 
! arrangem5t may take effect ) respect  
to su* employee4  4  7b7 ,no inf]5ce ,to
 ! ext5t n inconsi/5t ) ! am5dm5ts made 
by ?is section--  7#a7 no inf]5ce %all  

be made f su* am5dm5ts ) respect to !   
rules prescrib$ 9 ! ,f$]al ,regi/] on   
,june #bj1 #bjai1 7#hd ,f$4 ,reg4       
#bhhhh7 relat+ to heal? reimbursem5t    
arrangem5ts & o!r acc\nt-bas$ gr\p heal?
 plans1 &  7#b7 any ref]5ce to cu/om    
heal? option & individual c>e exp5se    
arrangem5ts %all = purposes ( su* rules 
be treat$ z includ+ a ref]5ce to        
individual cov]age heal? reimbursem5t   
arrangem5ts4  7c7 ,effective date ,!    
am5dm5ts made by ?is section %all apply 
to plan ye>s beg9n+ aft] ,decemb] #ca1  
#bjbc4  ,,iii ,self-,insurance          
,protection ,act  #cja4 ,%ort title ,?is
 title may be cit$ z ! ,self-,insurance 
,protection ,act4  #cjb4 ,f9d+s         
,congress f9ds ! foll[+3 7#a7 ,small &  
l>ge employ]s (f] heal? b5efit plan     
cov]age to employees 9 self-fund$       
arrangem5ts us+ company assets or a     
fund1 or by pay+ premiums to pur*ase    
fully-insur$ cov]age f a heal? insurance
 company4  7#b7 ,employ]s t self-fund   
heal? b5efit plans w (t5 pur*ase        

/op-loss insurance z a f9ancial risk    
managem5t tool to protect aga9/ excess  
or unexpect$ cata/rophic heal? plan     
claims losses t arise above project$    
co/s paid out ( company assets4  7#c7   
,/op-loss cov]age insures ! employ]     
sponsor+ ! heal? b5efit plan aga9/      
un=ese5 heal? plan claims1 does n insure
 ! employee heal? b5efit plan itself1 & 
does n pay heal? c>e provid]s = m$ical  
s]vices provid$ to ! employees4  7#d7   
,employ]-sponsor$ heal? b5efit plans are
 regulat$ "u ! ,employee ,retirem5t     
,income ,security ,act ( #aigd1 h[ev]1  
,/ates regulate ! availability & !      
cov]age t]ms ( /op-loss insurance       
cov]age t employ]s pur*ase to protect   
company assets & to protect a fund aga9/
 excess or unexpect$ claims losses4     
7#e7 ,bo? l>ge & small employ]s t *oose 
to self-fund mu/ also be able to protect
 company assets or a fund aga9/ excess  
or unexpect$ claims losses & ,/ates mu/ 
reasonably regulate /op-loss insurance  
to assure its availability to bo? l>ge &

 small employ]s4  #cjc4 ,c]ta9 m$ical   
/op-loss insurance obta9$ by c]ta9 plan 
sponsors ( gr\p heal? plans n includ$ "u
 ! def9ition ( heal? insurance cov]age  
,section #gcc7;b77#a7 ( ! ,employee     
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aaia;b7b77#a77 is 
am5d$ by add+ at ! end ! foll[+ s5t5ce3 
,su* t]m %all n include a /op-loss      
policy obta9$ by a self-insur$ gr\p     
heal? plan or a plan sponsor ( a gr\p   
heal? plan t self-insures ! heal? risks 
( its plan p>ticipants to reimburse !   
plan or sponsor = losses t ! plan or    
sponsor incurs 9 provid+ heal? or m$ical
 b5efits to su* plan p>ticipants 9      
excess ( a pr$et]m9$ level set =? 9 !   
/op-loss policy obta9$ by su* plan or   
sponsor44  #cjd4 ,effect on o!r laws    
,section #ead7;b7 ( ! ,employee         
,retirem5t ,income ,security ,act (     
#aigd 7#bi ,u4,s4,c4 #aadd7;b77 is am5d$
 by add+ at ! end ! foll[+3  7#aj7 ,!   
provisions ( ?is title 7includ+ "p #g   
relat+ to gr\p heal? plans7 %all preempt

 ,/ate laws ins(> z !y may n[ or h]eaft]
 prev5t an employee b5efit plan t is a  
gr\p heal? plan f insur+ aga9/ ! risk ( 
excess or unexpect$ heal? plan claims   
losses4  4  ,,iv ,small ,bus9ess        
,flexibility ,act  #dja4 ,%ort title    
,?is title may be cit$ z ! ,small       
,bus9ess ,flexibility ,act4  #djb4      
,notification ( flexible heal? insurance
 b5efits  7a7 ,9 g5]al ,sub*apt] ,c (   
*apt] #ajj ( ! ,int]nal ,rev5ue ,code ( 
#aihf is am5d$ by add+ at ! end ! foll[+
 new section3  #ihce4 ,notification (   
flexible heal? insurance b5efits  7a7 ,9
 g5]al ,n lat] ?an #a ye> aft] ! date ( 
enactm5t ( ?is section1 ! ,secret>y %all
 notify employ]s ( ! availability (     
tax-advantag$ flexible heal? insurance  
b5efits1 ) an initial focus on small    
bus9esses1 p>ticul>ly 9 rural areas 7z  
def9$ 9 section #acic7;a77#b774  7b7    
,def9itions ,9 ?is section3 7#a7        
,employ] ,! t]m employ] has ! mean+ giv5
 su* t]m 9 section #c7e7 ( ! ,employee  
,retirem5t ,income ,security ,act 7#bi  

,u4,s4,c4 #ajjb7e774  7#b7 ,flexible    
heal? insurance b5efits ,! t]m flexible 
heal? insurance b5efits means-- 7,a7 an 
individual contribution heal?           
reimbursem5t arrangem5t 7z describ$ 9 ! 
rule entitl$ ,heal? ,reimbursem5t       
,arrangem5ts & ,o!r ,acc\nt-,bas$ ,gr\p 
,heal? ,plans 7#hd ,f$4 ,reg4 #bhhhh    
7,june #bj1 #bjai772  7,b7 a qualifi$   
small employ] heal? reimbursem5t        
arrangem5t 7z def9$ 9 section           
#ihca7;d77#b772 &  7,c7 ! small employ] 
heal? insurance cr$it det]m9$ "u section
 #de,r4  4  7b7 ,cl]ical am5dm5t ,!     
table ( sections = sub*apt] ,c ( *apt]  
#ajj ( su* ,code is am5d$ by add+ at !  
end ! foll[+ new item3  ,sec4 #ihce4    
,notification ( flexible heal? insurance
 b5efits4  4  ,v ,rescissions  #eja4    
,prev5tion & ,public ,heal? ,fund       
,section #djjb7;b77#g7 ( ! ,pati5t      
,protection & ,af=dable ,c>e ,act 7#db  
,u4,s4,c4 #cjju-#aa7;b77#g77 is am5d$ by
 /rik+ = ea* ( fiscal ye>s #bjbd &      
#bjbe1 #a1cjj1jjj1jjj & ins]t+ = fiscal 

ye> #bjbd1 #a1jee1jjj1jjj1 & = fiscal   
ye> #bjbe1 #a1cjj1jjj1jjj4  ,,vi ,s5se (
 ,congress t ,am]icans %all h heal?c>e  
fre$om  #fja4 ,s5se ( ,congress t       
heal?c>e fre$om is ! future ,x is ! s5se
 ( ,congress t-- 7#a7 ! future (        
heal?c>e lies 9 heal?c>e fre$om1 n 9    
socializ$ m$ic9e2  7#b7 ,congress %\ld  
take /eps to address ! brok5 heal?c>e   
sy/em by re/or+ free m>ket practices to 
l[] co/s2  7#c7 cov]age is n c>e1 &     
exp&+ direct access to heal?c>e %\ld be 
prioritiz$ ov] exp&+ access to cov]age2 
&  7#d7 pati5ts & doctors1 n gov]nm5t   
bureaucrats or insurance bureaucrats1   
%\ld make heal?c>e decisions4  ,pass$ ! 
,h\se ( ,repres5tatives ,june #ba1      
#bjbc4;,cl]k4