The bill would change federal rules for when an association of employers can be treated as an employer offering a group health plan. A qualifying association could include employers from different industries, must have at least 51 employees when members’ employees are counted together, and must have existed for at least two years. It must have been formed for reasons beyond providing medical care, offer coverage without health-based membership limits, and be run by a governing board made up mostly of elected participating employers. The bill also sets conditions for self-employed people to join and requires the association’s board to check that they continue to qualify.
Plans could set base premium rates using pooled claims and could adjust employer members’ contributions based on each member’s risk, subject to state law. A plan made up only of self-employed people must use one risk pool and charge each participant the same rate. Plans could not discriminate based on health status or deny coverage for pre-existing conditions. The bill says offering plan coverage does not by itself establish an employer relationship under federal or state law, and it keeps existing health plan requirements in place.
Employees of participating employers, and qualifying self-employed people, could be eligible for coverage through an association plan. Plans could not deny eligibility or charge higher contributions based on a person’s health status, or deny coverage for a pre-existing condition. The bill does not guarantee that an association plan will be available to any particular person.
The bill does not state government spending or set specific premium amounts. It allows certain plans to adjust employer members’ contributions based on risk, subject to state law. Plans made up only of self-employed people must charge all participants the same premium rate.
No publicly available information.
No publicly available information.