,,ii #aaith ,,congress #ast ,session ,s4 #ahdg ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #ba1 #bjbe,mr4 ,paul 7for himself and ,mr4 ,wicker7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 and ,pensions ,a ,,bill ,to amend the ,employee ,retirement ,income ,security ,act of #aigd to clarify the treatment of certain association health plans as employers1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,association ,health ,plans ,act4 #b4 ,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 years2 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 may participate in the group or association as a member2 7ii7 is structured in good faith with any set of criteria to qualify for such treatment in any advisory opinion issued 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 a bona fide 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 a 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 to 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 participants in a single plan multiple employer welfare arrangement2 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 #c4 ,rules applicable to employee welfare benefit 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 #aaha et seq47 is amended by adding at the end the following3 #gcf4 ,rules applicable to employee welfare benefit 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 an employee welfare benefit plan established and maintained by a group or association of employers described in section #c7e77;,b71 such plan may1 to the extent not prohibited under ,state law-- 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 employee welfare benefit 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 ,an employee welfare benefit 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 #d4 ,rule of construction ,nothing in this ,act 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 et 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