H.R. 2528

[Congressional Bills 119th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2528 Reported in House (RH)]

<DOC>

Union Calendar No. 357
119th CONGRESS
1st Session
H. R. 2528

[Report No. 119-409]

To amend the Employee Retirement Income Security Act of 1974 to clarify 
the treatment of certain association health plans as employers, and for 
other purposes.

_______________________________________________________________________

IN THE HOUSE OF REPRESENTATIVES

April 1, 2025

Mr. Walberg (for himself, Mr. Allen, Mr. Onder, Mr. Crenshaw, Mrs. 
Bice, Mr. Kiley of California, Mr. Grothman, Mr. Mackenzie, and Mr. 
Huizenga) introduced the following bill; which was referred to the 
Committee on Education and Workforce

December 15, 2025

Additional sponsors: Mr. Owens, Mr. Harris of North Carolina, Mr. 
Thompson of Pennsylvania, Mr. Hill of Arkansas, Mr. Smith of Nebraska, 
Mr. Biggs of Arizona, Mr. Cuellar, Mr. Van Drew, Mr. Weber of Texas, 
Mrs. Fischbach, Mr. Hunt, Mr. Goldman of Texas, Mr. Gosar, Mr. Messmer, 
Mr. Smith of New Jersey, Mr. Ciscomani, Mr. Hamadeh of Arizona, Mr. 
Bishop, Mr. Meuser, Mr. Barr, Mr. Dunn of Florida, Mr. Calvert, Mr. 
Fitzgerald, and Mr. Schweikert

December 15, 2025

Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed
[Strike out all after the enacting clause and insert the part printed 
in italic]
[For text of introduced bill, see copy of bill as introduced on April 
1, 2025]

_______________________________________________________________________

A BILL

To amend the Employee Retirement Income Security Act of 1974 to clarify 
the treatment of certain association health plans as employers, and for 
other purposes.

Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Association Health Plans Act''.

SEC. 2. TREATMENT OF GROUP OR ASSOCIATION OF EMPLOYERS.

(a) In General.--Section 3(5) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1002(5)) is amended--
(1) by striking ``The term'' and inserting ``(A) The 
term''; and
(2) by adding at the end the following:
``(B) For purposes of subparagraph (A), a group or association of 
employers shall be treated as an `employer' solely for purposes of 
sponsoring a group health plan, regardless of whether the employers 
composing such group or association are in the same industry, trade, or 
profession, if such group or association--
``(i)(I) has established and maintains an employee welfare 
benefit plan that is a group health plan (as defined in section 
733(a)(1));
``(II) provides coverage under such plan to at least 51 
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 
(D);
``(III) has been actively in existence for at least 2 
years;
``(IV) has been formed and maintained in good faith for 
purposes other than providing medical care (as defined in 
section 733(a)(2)) through the purchase of insurance or 
otherwise;
``(V) does not condition membership in the group or 
association on any health status-related factor (as described 
in section 702(a)(1)) relating to any individual;
``(VI) makes coverage under such plan available to all 
employer members of such group or association regardless of any 
health status-related factor (as described in section 
702(a)(1)) relating to such employer members;
``(VII) does not provide coverage under such plan to any 
individual other than an employee of an employer member of such 
group or association;
``(VIII) has established a governing board with by-laws or 
other similar indications of formality to manage and operate 
such plan in both form and substance, of which at least 75 
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 1 vote during a scheduled election; and
``(IX) is not a health insurance issuer (as defined in 
section 733(b)(2)), and is not owned or controlled by such a 
health insurance issuer or by a subsidiary or affiliate of such 
a health insurance issuer, other than to the extent such a 
health insurance issuer may participate in the group or 
association as a member;
``(ii) 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 
Act; or
``(iii) meets any other set of criteria to qualify for such 
treatment that the Secretary by regulation may provide.
``(C)(i) For purposes of subparagraph (B), a self-employed 
individual shall be treated as--
``(I) an employer who may become a member of a group or 
association of employers;
``(II) an employee who may participate in an employee 
welfare benefit plan established and maintained by such group 
or association; and
``(III) a participant of such plan subject to the 
eligibility determination and monitoring requirements set forth 
in clause (iii).
``(ii) For purposes of this subparagraph, the term `self-employed 
individual' means an individual who--
``(I) does not have any common law employees;
``(II) has a bona fide ownership right in a trade or 
business, regardless of whether such trade or business is 
incorporated or unincorporated;
``(III) earns wages (as defined in section 3121(a) of the 
Internal Revenue Code of 1986) or self-employment income (as 
defined in section 1402(b) of such Code) from such trade or 
business; and
``(IV) works at least 10 hours a week or 40 hours per month 
providing personal services to such trade or business.
``(iii) The board of a group or association of employers shall--
``(I) initially determine whether an individual meets the 
requirements under clause (ii) to be considered to a self-
employed individual for the purposes of being treated as an--
``(aa) employer member of such group or association 
(in accordance with clause (i)(I)); and
``(bb) employee who may participate in the employee 
welfare benefit plan established and maintained by such 
group or association (in accordance with clause 
(i)(II));
``(II) through reasonable monitoring procedures, 
periodically determine whether the individual continues to meet 
such requirements; and
``(III) if the board determines that an individual no 
longer meets such requirements, not make such plan coverage 
available to such individual (or dependents thereof) for any 
plan year following the plan year during which the board makes 
such determination. If, subsequent to a determination that an 
individual no longer meets such requirements, such individual 
furnishes evidence of satisfying such requirements, such 
individual (and dependents thereof) shall be eligible to 
receive plan coverage.
``(D) For purposes of subparagraph (B), all of the employees 
(including self-employed individuals) employed by all of the employer 
members (including self-employed individuals) of a group or association 
of employers shall be--
``(i) treated as participants in a single plan multiple 
employer welfare arrangement; and
``(ii) aggregated and counted together for purposes of any 
regulation of an employee welfare benefit plan established and 
maintained by such group or association.''.
(b) 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 law.

SEC. 3. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS ESTABLISHED 
AND MAINTAINED BY A GROUP OR ASSOCIATION OF EMPLOYERS.

(a) In General.--Part 7 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. 1181, et seq.) is 
amended by adding at the end the following:

``SEC. 736. RULES APPLICABLE TO EMPLOYEE WELFARE BENEFIT PLANS 
ESTABLISHED AND MAINTAINED BY A GROUP OR ASSOCIATION OF 
EMPLOYERS.

``(a) Premium Rates for a Group or Association of Employers.--
``(1)(A) In the case of an employee welfare benefit plan 
established and maintained by a group or association of 
employers described in section 3(5)(B), such plan may, to the 
extent not prohibited under State law--
``(i) establish base premium rates formed on an 
actuarially sound, modified community rating 
methodology that considers the pooling of all plan 
participant claims; and
``(ii) 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 rates.
``(B) For purposes of paragraph (1), the term `employer 
member' means--
``(i) an employer who is a member of such group or 
association of employers and employs at least 1 common 
law employee; or
``(ii) a group made up solely of self-employed 
individuals, within which all of the self-employed 
individual members of such group or association are 
aggregated together as a single employer member group, 
provided the group includes at least 20 self-employed 
individual members.
``(2) In the event a group or association is made up solely 
of self-employed individuals (and no employers with at least 1 
common law employee are members of such group or association), 
the employee welfare benefit plan established by such group or 
association shall--
``(A) treat all self-employed individuals who are 
members of such group or association as a single risk 
pool;
``(B) pool all plan participant claims; and
``(C) charge each plan participant the same premium 
rate.
``(b) Discrimination and Pre-Existing Condition Protections.--An 
employee welfare benefit plan established and maintained by a group or 
association of employers described in section 3(5)(B) shall be 
prohibited from--
``(1) establishing any rule for eligibility (including 
continued eligibility) of any individual (including an employee 
of an employer member or a self-employed individual, or a 
dependent of such employee or self-employed individual) to 
enroll for benefits under the terms of the plan that 
discriminates based on any health status-related factor that 
relates to such individual (consistent with the rules under 
section 702(a)(1));
``(2) requiring an individual (including an employee of an 
employer member or a self-employed individual, or a dependent 
of such employee or self-employed individual), as a condition 
of enrollment or continued enrollment under the plan, 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 (consistent with the rules under section 
702(b)(1)); and
``(3) denying coverage under such plan on the basis of a 
pre-existing condition (consistent with the rules under section 
2704 of the Public Health Service Act).''.
(b) Clerical Amendment.--The table of contents in section 1 of such 
Act is amended by inserting after the item relating to section 734 the 
following new items:

``Sec. 735. Standardized reporting format.
``Sec. 736. Rules applicable to employee welfare benefit plans 
established and maintained by a group or 
association of employers.''.

SEC. 4. 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 7 of subtitle 
B of title I of the Employee Retirement Income Security Act of 1974 (29 
U.S.C. 1181 et. seq.), including the provisions of part A of title 
XXVII of the Public Health Service Act as incorporated by reference 
into the Employee Retirement Income Security Act of 1974 through 
section 715 of such Act.
Union Calendar No. 357

119th CONGRESS

1st Session

H. R. 2528

[Report No. 119-409]

_______________________________________________________________________

A BILL

To amend the Employee Retirement Income Security Act of 1974 to clarify 
the treatment of certain association health plans as employers, and for 
other purposes.

_______________________________________________________________________

December 15, 2025

Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed