Rules applicable to employee welfare benefit plans established and maintained by a group or association of employers

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: 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)..

(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: 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..