IB 

Union Calendar No. 23 

115TH CONGRESS 

1ST SESSION H. R. 1101 

[Report No. 115–43] 

To amend title I of the Employee Retirement Income Security Act of 1974 

to improve access and choice for entrepreneurs with small businesses 

with respect to medical care for their employees. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 16, 2017 

Mr. SAM JOHNSON of Texas (for himself and Mr. WALBERG) introduced the 

following bill; which was referred to the Committee on Education and the 

Workforce 

MARCH 17, 2017 

Additional sponsors: Ms. STEFANIK, Mr. MITCHELL, Mr. STIVERS, Mr. FASO, 

Mr. BISHOP of Michigan, Mr. ROE of Tennessee, Mr. HUIZENGA, Ms. 

JENKINS of Kansas, Mr. ROKITA, Mr. ALLEN, Mr. GUTHRIE, Mr. SESSIONS, Mrs. WALORSKI, Mr. BOST, Mr. HENSARLING, Mr. WILSON of 

South Carolina, Mr. WEBER of Texas, Mr. PITTENGER, Mr. FLORES, Mr. 

CHABOT, Mr. ROUZER, Mr. HUNTER, Mr. FERGUSON, Mr. GROTHMAN, 

Mrs. RADEWAGEN, Mr. SMITH of Missouri, Mr. BYRNE, Mr. MESSER, 

Mr. DUNCAN of South Carolina, Mr. HULTGREN, Mr. MCCAUL, Mr. 

BILIRAKIS, Mr. SMUCKER, Mr. BARLETTA, Mr. TROTT, and Mr. CRAMER

MARCH 17, 2017 

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 February 16, 2017] 

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A BILL 

To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical 

care for their employees. 

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1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Small Business Health Fairness Act of 2017’’. 

6 (b) TABLE OF CONTENTS.—The table of contents for 

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

Sec. 2. Rules governing association health plans. 

Sec. 3. Clarification of treatment of single employer arrangements. 

Sec. 4. Enforcement provisions relating to association health plans. 

Sec. 5. Cooperation between Federal and State authorities. 

Sec. 6. Effective date and transitional and other rules. 

8 SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS. 

9 (a) IN GENERAL.—Subtitle B of title I of the Employee 

10 Retirement Income Security Act of 1974 is amended by 

11 adding after part 7 the following new part: 

12 ‘‘PART 8—RULES GOVERNING ASSOCIATION 

13 HEALTH PLANS 

14 ‘‘SEC. 801. ASSOCIATION HEALTH PLANS. 

15 ‘‘(a) IN GENERAL.—For purposes of this part, the term 

16 ‘association health plan’ means a group health plan whose 

17 sponsor is (or is deemed under this part to be) described 

18 in subsection (b). 

19 ‘‘(b) SPONSORSHIP.—The sponsor of a group health 

20 plan is described in this subsection if such sponsor— 

21 ‘‘(1) is organized and maintained in good faith, 

22 with a constitution and bylaws specifically stating its 

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1 purpose and providing for periodic meetings on at 

2 least an annual basis, as a bona fide trade associa3 tion, a bona fide industry association (including a 

4 rural electric cooperative association or a rural tele5 phone cooperative association), a bona fide profes6 sional association, or a bona fide chamber of com7 merce (or similar bona fide business association, in8 cluding a corporation or similar organization that 

9 operates on a cooperative basis (within the meaning 

10 of section 1381 of the Internal Revenue Code of 

11 1986)), for substantial purposes other than that of ob12 taining or providing medical care; 

13 ‘‘(2) is established as a permanent entity which 

14 receives the active support of its members and re15 quires for membership payment on a periodic basis of 

16 dues or payments necessary to maintain eligibility 

17 for membership in the sponsor; and 

18 ‘‘(3) does not condition membership, such dues or 

19 payments, or coverage under the plan on the basis of 

20 health status-related factors with respect to the em21 ployees of its members (or affiliated members), or the 

22 dependents of such employees, and does not condition 

23 such dues or payments on the basis of group health 

24 plan participation. 

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1 Any sponsor consisting of an association of entities which 

2 meet the requirements of paragraphs (1), (2), and (3) shall 

3 be deemed to be a sponsor described in this subsection. 

4 ‘‘SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH 

5 PLANS. 

6 ‘‘(a) IN GENERAL.—The applicable authority shall 

7 prescribe by regulation a procedure under which, subject to 

8 subsection (b), the applicable authority shall certify associa9 tion health plans which apply for certification as meeting 

10 the requirements of this part. 

11 ‘‘(b) STANDARDS.—Under the procedure prescribed 

12 pursuant to subsection (a), in the case of an association 

13 health plan that provides at least one benefit option which 

14 does not consist of health insurance coverage, the applicable 

15 authority shall certify such plan as meeting the require16 ments of this part only if the applicable authority is satis17 fied that the applicable requirements of this part are met 

18 (or, upon the date on which the plan is to commence oper19 ations, will be met) with respect to the plan. 

20 ‘‘(c) REQUIREMENTS APPLICABLE TO CERTIFIED

21 PLANS.—An association health plan with respect to which 

22 certification under this part is in effect shall meet the appli23 cable requirements of this part, effective on the date of cer24 tification (or, if later, on the date on which the plan is 

25 to commence operations). 

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1 ‘‘(d) REQUIREMENTS FOR CONTINUED CERTIFI2 CATION.—The applicable authority may provide by regula3 tion for continued certification of association health plans 

4 under this part. 

5 ‘‘(e) CLASS CERTIFICATION FOR FULLY INSURED

6 PLANS.—The applicable authority shall establish a class 

7 certification procedure for association health plans under 

8 which all benefits consist of health insurance coverage. 

9 Under such procedure, the applicable authority shall pro10 vide for the granting of certification under this part to the 

11 plans in each class of such association health plans upon 

12 appropriate filing under such procedure in connection with 

13 plans in such class and payment of the prescribed fee under 

14 section 807(a). 

15 ‘‘(f) CERTIFICATION OF SELF-INSURED ASSOCIATION

16 HEALTH PLANS.—An association health plan which offers 

17 one or more benefit options which do not consist of health 

18 insurance coverage may be certified under this part only 

19 if such plan consists of any of the following: 

20 ‘‘(1) A plan which offered such coverage on the 

21 date of the enactment of the Small Business Health 

22 Fairness Act of 2017. 

23 ‘‘(2) A plan under which the sponsor does not re24 strict membership to one or more trades and busi25 nesses or industries and whose eligible participating 

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1 employers represent a broad cross-section of trades 

2 and businesses or industries. 

3 ‘‘(3) A plan whose eligible participating employ4 ers represent one or more trades or businesses, or one 

5 or more industries, consisting of any of the following: 

6 agriculture; equipment and automobile dealerships; 

7 barbering and cosmetology; certified public account8 ing practices; child care; construction; dance, theat9 rical and orchestra productions; disinfecting and pest 

10 control; financial services; fishing; food service estab11 lishments; hospitals; labor organizations; logging; 

12 manufacturing (metals); mining; medical and dental 

13 practices; medical laboratories; professional consulting 

14 services; sanitary services; transportation (local and 

15 freight); warehousing; wholesaling/distributing; or 

16 any other trade or business or industry which has 

17 been indicated as having average or above-average 

18 risk or health claims experience by reason of State 

19 rate filings, denials of coverage, proposed premium 

20 rate levels, or other means demonstrated by such plan 

21 in accordance with regulations. 

22 ‘‘SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND 

23 BOARDS OF TRUSTEES. 

24 ‘‘(a) SPONSOR.—The requirements of this subsection 

25 are met with respect to an association health plan if the 

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1 sponsor has met (or is deemed under this part to have met) 

2 the requirements of section 801(b) for a continuous period 

3 of not less than 3 years ending with the date of the applica4 tion for certification under this part. 

5 ‘‘(b) BOARD OF TRUSTEES.—The requirements of this 

6 subsection are met with respect to an association health 

7 plan if the following requirements are met: 

8 ‘‘(1) FISCAL CONTROL.—The plan is operated, 

9 pursuant to a trust agreement, by a board of trustees 

10 which has complete fiscal control over the plan and 

11 which is responsible for all operations of the plan. 

12 ‘‘(2) RULES OF OPERATION AND FINANCIAL CON13 TROLS.—The board of trustees has in effect rules of 

14 operation and financial controls, based on a 3-year 

15 plan of operation, adequate to carry out the terms of 

16 the plan and to meet all requirements of this title ap17 plicable to the plan. 

18 ‘‘(3) RULES GOVERNING RELATIONSHIP TO PAR19 TICIPATING EMPLOYERS AND TO CONTRACTORS.— 

20 ‘‘(A) BOARD MEMBERSHIP.— 

21 ‘‘(i) IN GENERAL.—Except as provided 

22 in clauses (ii) and (iii), the members of the 

23 board of trustees are individuals selected 

24 from individuals who are the owners, offi25 cers, directors, or employees of the particimstockstill on DSK30JT082PROD with BILLS

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1 pating employers or who are partners in the 

2 participating employers and actively par3 ticipate in the business. 

4 ‘‘(ii) LIMITATION.— 

5 ‘‘(I) GENERAL RULE.—Except as 

6 provided in subclauses (II) and (III), 

7 no such member is an owner, officer, 

8 director, or employee of, or partner in, 

9 a contract administrator or other serv10 ice provider to the plan. 

11 ‘‘(II) LIMITED EXCEPTION FOR

12 PROVIDERS OF SERVICES SOLELY ON

13 BEHALF OF THE SPONSOR.—Officers or 

14 employees of a sponsor which is a serv15 ice provider (other than a contract ad16 ministrator) to the plan may be mem17 bers of the board if they constitute not 

18 more than 25 percent of the member19 ship of the board and they do not pro20 vide services to the plan other than on 

21 behalf of the sponsor. 

22 ‘‘(III) TREATMENT OF PROVIDERS

23 OF MEDICAL CARE.—In the case of a 

24 sponsor which is an association whose 

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1 viders of medical care, subclause (I) 

2 shall not apply in the case of any serv3 ice provider described in subclause (I) 

4 who is a provider of medical care 

5 under the plan. 

6 ‘‘(iii) CERTAIN PLANS EXCLUDED.— 

7 Clause (i) shall not apply to an association 

8 health plan which is in existence on the 

9 date of the enactment of the Small Business 

10 Health Fairness Act of 2017. 

11 ‘‘(B) SOLE AUTHORITY.—The board has sole 

12 authority under the plan to approve applications 

13 for participation in the plan and to contract 

14 with a service provider to administer the day-to15 day affairs of the plan. 

16 ‘‘(c) TREATMENT OF FRANCHISE NETWORKS.—In the 

17 case of a group health plan which is established and main18 tained by a franchiser for a franchise network consisting 

19 of its franchisees— 

20 ‘‘(1) the requirements of subsection (a) and sec21 tion 801(a) shall be deemed met if such requirements 

22 would otherwise be met if the franchiser were deemed 

23 to be the sponsor referred to in section 801(b), such 

24 network were deemed to be an association described in 

25 section 801(b), and each franchisee were deemed to be 

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1 a member (of the association and the sponsor) referred 

2 to in section 801(b); and 

3 ‘‘(2) the requirements of section 804(a)(1) shall 

4 be deemed met. 

5 The Secretary may by regulation define for purposes of this 

6 subsection the terms ‘franchiser’, ‘franchise network’, and 

7 ‘franchisee’. 

8 ‘‘SEC. 804. PARTICIPATION AND COVERAGE REQUIRE9 MENTS. 

10 ‘‘(a) COVERED EMPLOYERS AND INDIVIDUALS.—The 

11 requirements of this subsection are met with respect to an 

12 association health plan if, under the terms of the plan— 

13 ‘‘(1) each participating employer must be— 

14 ‘‘(A) a member of the sponsor, 

15 ‘‘(B) the sponsor, or 

16 ‘‘(C) an affiliated member of the sponsor 

17 with respect to which the requirements of sub18 section (b) are met, 

19 except that, in the case of a sponsor which is a profes20 sional association or other individual-based associa21 tion, if at least one of the officers, directors, or em22 ployees of an employer, or at least one of the individ23 uals who are partners in an employer and who ac24 tively participates in the business, is a member or 

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1 pating employers may also include such employer; 

2 and 

3 ‘‘(2) all individuals commencing coverage under 

4 the plan after certification under this part must be— 

5 ‘‘(A) active or retired owners (including 

6 self-employed individuals), officers, directors, or 

7 employees of, or partners in, participating em8 ployers; or 

9 ‘‘(B) the beneficiaries of individuals de10 scribed in subparagraph (A). 

11 ‘‘(b) COVERAGE OF PREVIOUSLY UNINSURED EMPLOY12 EES.—In the case of an association health plan in existence 

13 on the date of the enactment of the Small Business Health 

14 Fairness Act of 2017, an affiliated member of the sponsor 

15 of the plan may be offered coverage under the plan as a 

16 participating employer only if— 

17 ‘‘(1) the affiliated member was an affiliated 

18 member on the date of certification under this part; 

19 or 

20 ‘‘(2) during the 12-month period preceding the 

21 date of the offering of such coverage, the affiliated 

22 member has not maintained or contributed to a group 

23 health plan with respect to any of its employees who 

24 would otherwise be eligible to participate in such as25 sociation health plan. 

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1 ‘‘(c) INDIVIDUAL MARKET UNAFFECTED.—The re2 quirements of this subsection are met with respect to an 

3 association health plan if, under the terms of the plan, no 

4 participating employer may provide health insurance cov5 erage in the individual market for any employee not covered 

6 under the plan which is similar to the coverage contempora7 neously provided to employees of the employer under the 

8 plan, if such exclusion of the employee from coverage under 

9 the plan is based on a health status-related factor with re10 spect to the employee and such employee would, but for such 

11 exclusion on such basis, be eligible for coverage under the 

12 plan. 

13 ‘‘(d) PROHIBITION OF DISCRIMINATION AGAINST EM14 PLOYERS AND EMPLOYEES ELIGIBLE TO PARTICIPATE.— 

15 The requirements of this subsection are met with respect to 

16 an association health plan if— 

17 ‘‘(1) under the terms of the plan, all employers 

18 meeting the preceding requirements of this section are 

19 eligible to qualify as participating employers for all 

20 geographically available coverage options, unless, in 

21 the case of any such employer, participation or con22 tribution requirements of the type referred to in sec23 tion 2711 of the Public Health Service Act are not 

24 met; 

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1 ‘‘(2) upon request, any employer eligible to par2 ticipate is furnished information regarding all cov3 erage options available under the plan; and 

4 ‘‘(3) the applicable requirements of sections 701, 

5 702, and 703 are met with respect to the plan. 

6 ‘‘SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN DOC7 UMENTS, CONTRIBUTION RATES, AND BEN8 EFIT OPTIONS. 

9 ‘‘(a) IN GENERAL.—The requirements of this section 

10 are met with respect to an association health plan if the 

11 following requirements are met: 

12 ‘‘(1) CONTENTS OF GOVERNING INSTRUMENTS.— 

13 The instruments governing the plan include a written 

14 instrument, meeting the requirements of an instru15 ment required under section 402(a)(1), which— 

16 ‘‘(A) provides that the board of trustees 

17 serves as the named fiduciary required for plans 

18 under section 402(a)(1) and serves in the capac19 ity of a plan administrator (referred to in sec20 tion 3(16)(A)); 

21 ‘‘(B) provides that the sponsor of the plan 

22 is to serve as plan sponsor (referred to in section 

23 3(16)(B)); and 

24 ‘‘(C) incorporates the requirements of sec25 tion 806. 

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1 ‘‘(2) CONTRIBUTION RATES MUST BE NON2 DISCRIMINATORY.— 

3 ‘‘(A) The contribution rates for any partici4 pating small employer do not vary on the basis 

5 of any health status-related factor in relation to 

6 employees of such employer or their beneficiaries 

7 and do not vary on the basis of the type of busi8 ness or industry in which such employer is en9 gaged. 

10 ‘‘(B) Nothing in this title or any other pro11 vision of law shall be construed to preclude an 

12 association health plan, or a health insurance 

13 issuer offering health insurance coverage in con14 nection with an association health plan, from— 

15 ‘‘(i) setting contribution rates based on 

16 the claims experience of the plan; or 

17 ‘‘(ii) varying contribution rates for 

18 small employers in a State to the extent 

19 that such rates could vary using the same 

20 methodology employed in such State for reg21 ulating premium rates in the small group 

22 market with respect to health insurance cov23 erage offered in connection with bona fide 

24 associations (within the meaning of section 

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1 2791(d)(3) of the Public Health Service 

2 Act), 

3 subject to the requirements of section 702(b) re4 lating to contribution rates. 

5 ‘‘(3) FLOOR FOR NUMBER OF COVERED INDIVID6 UALS WITH RESPECT TO CERTAIN PLANS.—If any 

7 benefit option under the plan does not consist of 

8 health insurance coverage, the plan has as of the be9 ginning of the plan year not fewer than 1,000 partici10 pants and beneficiaries. 

11 ‘‘(4) MARKETING REQUIREMENTS.— 

12 ‘‘(A) IN GENERAL.—If a benefit option 

13 which consists of health insurance coverage is of14 fered under the plan, State-licensed insurance 

15 agents shall be used to distribute to small em16 ployers coverage which does not consist of health 

17 insurance coverage in a manner comparable to 

18 the manner in which such agents are used to dis19 tribute health insurance coverage. 

20 ‘‘(B) STATE-LICENSED INSURANCE

21 AGENTS.—For purposes of subparagraph (A), the 

22 term ‘State-licensed insurance agents’ means one 

23 or more agents who are licensed in a State and 

24 are subject to the laws of such State relating to 

25 licensure, qualification, testing, examination, 

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1 and continuing education of persons authorized 

2 to offer, sell, or solicit health insurance coverage 

3 in such State. 

4 ‘‘(5) REGULATORY REQUIREMENTS.—Such other 

5 requirements as the applicable authority determines 

6 are necessary to carry out the purposes of this part, 

7 which shall be prescribed by the applicable authority 

8 by regulation. 

9 ‘‘(b) ABILITY OF ASSOCIATION HEALTH PLANS TO DE10 SIGN BENEFIT OPTIONS.—Subject to section 514(d), noth11 ing in this part or any provision of State law (as defined 

12 in section 514(c)(1)) shall be construed to preclude an asso13 ciation health plan, or a health insurance issuer offering 

14 health insurance coverage in connection with an association 

15 health plan, from exercising its sole discretion in selecting 

16 the specific items and services consisting of medical care 

17 to be included as benefits under such plan or coverage, ex18 cept (subject to section 514) in the case of (1) any law to 

19 the extent that it is not preempted under section 731(a)(1) 

20 with respect to matters governed by section 711, 712, or 

21 713, or (2) any law of the State with which filing and ap22 proval of a policy type offered by the plan was initially 

23 obtained to the extent that such law prohibits an exclusion 

24 of a specific disease from such coverage. 

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1 ‘‘SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS 

2 FOR SOLVENCY FOR PLANS PROVIDING 

3 HEALTH BENEFITS IN ADDITION TO HEALTH 

4 INSURANCE COVERAGE. 

5 ‘‘(a) IN GENERAL.—The requirements of this section 

6 are met with respect to an association health plan if— 

7 ‘‘(1) the benefits under the plan consist solely of 

8 health insurance coverage; or 

9 ‘‘(2) if the plan provides any additional benefit 

10 options which do not consist of health insurance cov11 erage, the plan— 

12 ‘‘(A) establishes and maintains reserves 

13 with respect to such additional benefit options, 

14 in amounts recommended by the qualified actu15 ary, consisting of— 

16 ‘‘(i) a reserve sufficient for unearned 

17 contributions; 

18 ‘‘(ii) a reserve sufficient for benefit li19 abilities which have been incurred, which 

20 have not been satisfied, and for which risk 

21 of loss has not yet been transferred, and for 

22 expected administrative costs with respect to 

23 such benefit liabilities; 

24 ‘‘(iii) a reserve sufficient for any other 

25 obligations of the plan; and 

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1 ‘‘(iv) a reserve sufficient for a margin 

2 of error and other fluctuations, taking into 

3 account the specific circumstances of the 

4 plan; and 

5 ‘‘(B) establishes and maintains aggregate 

6 and specific excess/stop loss insurance and sol7 vency indemnification, with respect to such addi8 tional benefit options for which risk of loss has 

9 not yet been transferred, as follows: 

10 ‘‘(i) The plan shall secure aggregate ex11 cess/stop loss insurance for the plan with an 

12 attachment point which is not greater than 

13 125 percent of expected gross annual claims. 

14 The applicable authority may by regulation 

15 provide for upward adjustments in the 

16 amount of such percentage in specified cir17 cumstances in which the plan specifically 

18 provides for and maintains reserves in ex19 cess of the amounts required under subpara20 graph (A). 

21 ‘‘(ii) The plan shall secure specific ex22 cess/stop loss insurance for the plan with an 

23 attachment point which is at least equal to 

24 an amount recommended by the plan’s 

25 qualified actuary. The applicable authority 

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1 may by regulation provide for adjustments 

2 in the amount of such insurance in speci3 fied circumstances in which the plan spe4 cifically provides for and maintains re5 serves in excess of the amounts required 

6 under subparagraph (A). 

7 ‘‘(iii) The plan shall secure indem8 nification insurance for any claims which 

9 the plan is unable to satisfy by reason of a 

10 plan termination. 

11 Any person issuing to a plan insurance described in clause 

12 (i), (ii), or (iii) of subparagraph (B) shall notify the Sec13 retary of any failure of premium payment meriting can14 cellation of the policy prior to undertaking such a cancella15 tion. Any regulations prescribed by the applicable authority 

16 pursuant to clause (i) or (ii) of subparagraph (B) may 

17 allow for such adjustments in the required levels of excess/ 

18 stop loss insurance as the qualified actuary may rec19 ommend, taking into account the specific circumstances of 

20 the plan. 

21 ‘‘(b) MINIMUM SURPLUS IN ADDITION TO CLAIMS RE22 SERVES.—In the case of any association health plan de23 scribed in subsection (a)(2), the requirements of this sub24 section are met if the plan establishes and maintains sur25 plus in an amount at least equal to— 

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1 ‘‘(1) $500,000, or 

2 ‘‘(2) such greater amount (but not greater than 

3 $2,000,000) as may be set forth in regulations pre4 scribed by the applicable authority, considering the 

5 level of aggregate and specific excess/stop loss insur6 ance provided with respect to such plan and other 

7 factors related to solvency risk, such as the plan’s pro8 jected levels of participation or claims, the nature of 

9 the plan’s liabilities, and the types of assets available 

10 to assure that such liabilities are met. 

11 ‘‘(c) ADDITIONAL REQUIREMENTS.—In the case of any 

12 association health plan described in subsection (a)(2), the 

13 applicable authority may provide such additional require14 ments relating to reserves, excess/stop loss insurance, and 

15 indemnification insurance as the applicable authority con16 siders appropriate. Such requirements may be provided by 

17 regulation with respect to any such plan or any class of 

18 such plans. 

19 ‘‘(d) ADJUSTMENTS FOR EXCESS/STOP LOSS INSUR20 ANCE.—The applicable authority may provide for adjust21 ments to the levels of reserves otherwise required under sub22 sections (a) and (b) with respect to any plan or class of 

23 plans to take into account excess/stop loss insurance pro24 vided with respect to such plan or plans. 

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1 ‘‘(e) ALTERNATIVE MEANS OF COMPLIANCE.—The ap2 plicable authority may permit an association health plan 

3 described in subsection (a)(2) to substitute, for all or part 

4 of the requirements of this section (except subsection 

5 (a)(2)(B)(iii)), such security, guarantee, hold-harmless ar6 rangement, or other financial arrangement as the applica7 ble authority determines to be adequate to enable the plan 

8 to fully meet all its financial obligations on a timely basis 

9 and is otherwise no less protective of the interests of partici10 pants and beneficiaries than the requirements for which it 

11 is substituted. The applicable authority may take into ac12 count, for purposes of this subsection, evidence provided by 

13 the plan or sponsor which demonstrates an assumption of 

14 liability with respect to the plan. Such evidence may be 

15 in the form of a contract of indemnification, lien, bonding, 

16 insurance, letter of credit, recourse under applicable terms 

17 of the plan in the form of assessments of participating em18 ployers, security, or other financial arrangement. 

19 ‘‘(f) MEASURES TO ENSURE CONTINUED PAYMENT OF

20 BENEFITS BY CERTAIN PLANS IN DISTRESS.— 

21 ‘‘(1) PAYMENTS BY CERTAIN PLANS TO ASSOCIA22 TION HEALTH PLAN FUND.— 

23 ‘‘(A) IN GENERAL.—In the case of an asso24 ciation health plan described in subsection 

25 (a)(2), the requirements of this subsection are 

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1 met if the plan makes payments into the Asso2 ciation Health Plan Fund under this subpara3 graph when they are due. Such payments shall 

4 consist of annual payments in the amount of 

5 $5,000, and, in addition to such annual pay6 ments, such supplemental payments as the Sec7 retary may determine to be necessary under 

8 paragraph (2). Payments under this paragraph 

9 are payable to the Fund at the time determined 

10 by the Secretary. Initial payments are due in 

11 advance of certification under this part. Pay12 ments shall continue to accrue until a plan’s as13 sets are distributed pursuant to a termination 

14 procedure. 

15 ‘‘(B) PENALTIES FOR FAILURE TO MAKE

16 PAYMENTS.—If any payment is not made by a 

17 plan when it is due, a late payment charge of 

18 not more than 100 percent of the payment which 

19 was not timely paid shall be payable by the plan 

20 to the Fund. 

21 ‘‘(C) CONTINUED DUTY OF THE SEC22 RETARY.—The Secretary shall not cease to carry 

23 out the provisions of paragraph (2) on account 

24 of the failure of a plan to pay any payment 

25 when due. 

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1 ‘‘(2) PAYMENTS BY SECRETARY TO CONTINUE EX2 CESS/STOP LOSS INSURANCE COVERAGE AND INDEM3 NIFICATION INSURANCE COVERAGE FOR CERTAIN

4 PLANS.—In any case in which the applicable author5 ity determines that there is, or that there is reason to 

6 believe that there will be: (A) A failure to take nec7 essary corrective actions under section 809(a) with re8 spect to an association health plan described in sub9 section (a)(2); or (B) a termination of such a plan 

10 under section 809(b) or 810(b)(8) (and, if the appli11 cable authority is not the Secretary, certifies such de12 termination to the Secretary), the Secretary shall de13 termine the amounts necessary to make payments to 

14 an insurer (designated by the Secretary) to maintain 

15 in force excess/stop loss insurance coverage or indem16 nification insurance coverage for such plan, if the 

17 Secretary determines that there is a reasonable expec18 tation that, without such payments, claims would not 

19 be satisfied by reason of termination of such coverage. 

20 The Secretary shall, to the extent provided in advance 

21 in appropriation Acts, pay such amounts so deter22 mined to the insurer designated by the Secretary. 

23 ‘‘(3) ASSOCIATION HEALTH PLAN FUND.— 

24 ‘‘(A) IN GENERAL.—There is established on 

25 the books of the Treasury a fund to be known as 

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1 the ‘Association Health Plan Fund’. The Fund 

2 shall be available for making payments pursuant 

3 to paragraph (2). The Fund shall be credited 

4 with payments received pursuant to paragraph 

5 (1)(A), penalties received pursuant to paragraph 

6 (1)(B); and earnings on investments of amounts 

7 of the Fund under subparagraph (B). 

8 ‘‘(B) INVESTMENT.—Whenever the Secretary 

9 determines that the moneys of the fund are in ex10 cess of current needs, the Secretary may request 

11 the investment of such amounts as the Secretary 

12 determines advisable by the Secretary of the 

13 Treasury in obligations issued or guaranteed by 

14 the United States. 

15 ‘‘(g) EXCESS/STOP LOSS INSURANCE.—For purposes 

16 of this section— 

17 ‘‘(1) AGGREGATE EXCESS/STOP LOSS INSUR18 ANCE.—The term ‘aggregate excess/stop loss insur19 ance’ means, in connection with an association health 

20 plan, a contract— 

21 ‘‘(A) under which an insurer (meeting such 

22 minimum standards as the applicable authority 

23 may prescribe by regulation) provides for pay24 ment to the plan with respect to aggregate claims 

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1 under the plan in excess of an amount or 

2 amounts specified in such contract; 

3 ‘‘(B) which is guaranteed renewable; and 

4 ‘‘(C) which allows for payment of premiums 

5 by any third party on behalf of the insured plan. 

6 ‘‘(2) SPECIFIC EXCESS/STOP LOSS INSURANCE.— 

7 The term ‘specific excess/stop loss insurance’ means, 

8 in connection with an association health plan, a con9 tract— 

10 ‘‘(A) under which an insurer (meeting such 

11 minimum standards as the applicable authority 

12 may prescribe by regulation) provides for pay13 ment to the plan with respect to claims under 

14 the plan in connection with a covered individual 

15 in excess of an amount or amounts specified in 

16 such contract in connection with such covered in17 dividual; 

18 ‘‘(B) which is guaranteed renewable; and 

19 ‘‘(C) which allows for payment of premiums 

20 by any third party on behalf of the insured plan. 

21 ‘‘(h) INDEMNIFICATION INSURANCE.—For purposes of 

22 this section, the term ‘indemnification insurance’ means, in 

23 connection with an association health plan, a contract— 

24 ‘‘(1) under which an insurer (meeting such min25 imum standards as the applicable authority may premstockstill on DSK30JT082PROD with BILLS

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1 scribe by regulation) provides for payment to the plan 

2 with respect to claims under the plan which the plan 

3 is unable to satisfy by reason of a termination pursu4 ant to section 809(b) (relating to mandatory termi5 nation); 

6 ‘‘(2) which is guaranteed renewable and 

7 noncancellable for any reason (except as the applica8 ble authority may prescribe by regulation); and 

9 ‘‘(3) which allows for payment of premiums by 

10 any third party on behalf of the insured plan. 

11 ‘‘(i) RESERVES.—For purposes of this section, the term 

12 ‘reserves’ means, in connection with an association health 

13 plan, plan assets which meet the fiduciary standards under 

14 part 4 and such additional requirements regarding liquid15 ity as the applicable authority may prescribe by regulation. 

16 ‘‘(j) SOLVENCY STANDARDS WORKING GROUP.— 

17 ‘‘(1) IN GENERAL.—Within 90 days after the 

18 date of the enactment of the Small Business Health 

19 Fairness Act of 2017, the applicable authority shall 

20 establish a Solvency Standards Working Group. In 

21 prescribing the initial regulations under this section, 

22 the applicable authority shall take into account the 

23 recommendations of such Working Group. 

24 ‘‘(2) MEMBERSHIP.—The Working Group shall 

25 consist of not more than 15 members appointed by the 

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1 applicable authority. The applicable authority shall 

2 include among persons invited to membership on the 

3 Working Group at least one of each of the following: 

4 ‘‘(A) A representative of the National Asso5 ciation of Insurance Commissioners. 

6 ‘‘(B) A representative of the American 

7 Academy of Actuaries. 

8 ‘‘(C) A representative of the State govern9 ments, or their interests. 

10 ‘‘(D) A representative of existing self-in11 sured arrangements, or their interests. 

12 ‘‘(E) A representative of associations of the 

13 type referred to in section 801(b)(1), or their in14 terests. 

15 ‘‘(F) A representative of multiemployer 

16 plans that are group health plans, or their inter17 ests. 

18 ‘‘SEC. 807. REQUIREMENTS FOR APPLICATION AND RE19 LATED REQUIREMENTS. 

20 ‘‘(a) FILING FEE.—Under the procedure prescribed 

21 pursuant to section 802(a), an association health plan shall 

22 pay to the applicable authority at the time of filing an ap23 plication for certification under this part a filing fee in 

24 the amount of $5,000, which shall be available in the case 

25 of the Secretary, to the extent provided in appropriation 

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1 Acts, for the sole purpose of administering the certification 

2 procedures applicable with respect to association health 

3 plans. 

4 ‘‘(b) INFORMATION TO BE INCLUDED IN APPLICATION

5 FOR CERTIFICATION.—An application for certification 

6 under this part meets the requirements of this section only 

7 if it includes, in a manner and form which shall be pre8 scribed by the applicable authority by regulation, at least 

9 the following information: 

10 ‘‘(1) IDENTIFYING INFORMATION.—The names 

11 and addresses of— 

12 ‘‘(A) the sponsor; and 

13 ‘‘(B) the members of the board of trustees of 

14 the plan. 

15 ‘‘(2) STATES IN WHICH PLAN INTENDS TO DO

16 BUSINESS.—The States in which participants and 

17 beneficiaries under the plan are to be located and the 

18 number of them expected to be located in each such 

19 State. 

20 ‘‘(3) BONDING REQUIREMENTS.—Evidence pro21 vided by the board of trustees that the bonding re22 quirements of section 412 will be met as of the date 

23 of the application or (if later) commencement of oper24 ations. 

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1 ‘‘(4) PLAN DOCUMENTS.—A copy of the docu2 ments governing the plan (including any bylaws and 

3 trust agreements), the summary plan description, and 

4 other material describing the benefits that will be pro5 vided to participants and beneficiaries under the 

6 plan. 

7 ‘‘(5) AGREEMENTS WITH SERVICE PROVIDERS.— 

8 A copy of any agreements between the plan and con9 tract administrators and other service providers. 

10 ‘‘(6) FUNDING REPORT.—In the case of associa11 tion health plans providing benefits options in addi12 tion to health insurance coverage, a report setting 

13 forth information with respect to such additional ben14 efit options determined as of a date within the 120- 

15 day period ending with the date of the application, 

16 including the following: 

17 ‘‘(A) RESERVES.—A statement, certified by 

18 the board of trustees of the plan, and a statement 

19 of actuarial opinion, signed by a qualified actu20 ary, that all applicable requirements of section 

21 806 are or will be met in accordance with regu22 lations which the applicable authority shall pre23 scribe. 

24 ‘‘(B) ADEQUACY OF CONTRIBUTION

25 RATES.—A statement of actuarial opinion, 

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1 signed by a qualified actuary, which sets forth a 

2 description of the extent to which contribution 

3 rates are adequate to provide for the payment of 

4 all obligations and the maintenance of required 

5 reserves under the plan for the 12-month period 

6 beginning with such date within such 120-day 

7 period, taking into account the expected coverage 

8 and experience of the plan. If the contribution 

9 rates are not fully adequate, the statement of ac10 tuarial opinion shall indicate the extent to which 

11 the rates are inadequate and the changes needed 

12 to ensure adequacy. 

13 ‘‘(C) CURRENT AND PROJECTED VALUE OF

14 ASSETS AND LIABILITIES.—A statement of actu15 arial opinion signed by a qualified actuary, 

16 which sets forth the current value of the assets 

17 and liabilities accumulated under the plan and 

18 a projection of the assets, liabilities, income, and 

19 expenses of the plan for the 12-month period re20 ferred to in subparagraph (B). The income state21 ment shall identify separately the plan’s admin22 istrative expenses and claims. 

23 ‘‘(D) COSTS OF COVERAGE TO BE CHARGED

24 AND OTHER EXPENSES.—A statement of the costs 

25 of coverage to be charged, including an 

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1 itemization of amounts for administration, re2 serves, and other expenses associated with the op3 eration of the plan. 

4 ‘‘(E) OTHER INFORMATION.—Any other in5 formation as may be determined by the applica6 ble authority, by regulation, as necessary to 

7 carry out the purposes of this part. 

8 ‘‘(c) FILING NOTICE OF CERTIFICATION WITH

9 STATES.—A certification granted under this part to an as10 sociation health plan shall not be effective unless written 

11 notice of such certification is filed with the applicable State 

12 authority of each State in which at least 25 percent of the 

13 participants and beneficiaries under the plan are located. 

14 For purposes of this subsection, an individual shall be con15 sidered to be located in the State in which a known address 

16 of such individual is located or in which such individual 

17 is employed. 

18 ‘‘(d) NOTICE OF MATERIAL CHANGES.—In the case of 

19 any association health plan certified under this part, de20 scriptions of material changes in any information which 

21 was required to be submitted with the application for the 

22 certification under this part shall be filed in such form and 

23 manner as shall be prescribed by the applicable authority 

24 by regulation. The applicable authority may require by reg25 ulation prior notice of material changes with respect to 

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1 specified matters which might serve as the basis for suspen2 sion or revocation of the certification. 

3 ‘‘(e) REPORTING REQUIREMENTS FOR CERTAIN ASSO4 CIATION HEALTH PLANS.—An association health plan cer5 tified under this part which provides benefit options in ad6 dition to health insurance coverage for such plan year shall 

7 meet the requirements of section 103 by filing an annual 

8 report under such section which shall include information 

9 described in subsection (b)(6) with respect to the plan year 

10 and, notwithstanding section 104(a)(1)(A), shall be filed 

11 with the applicable authority not later than 90 days after 

12 the close of the plan year (or on such later date as may 

13 be prescribed by the applicable authority). The applicable 

14 authority may require by regulation such interim reports 

15 as it considers appropriate. 

16 ‘‘(f) ENGAGEMENT OF QUALIFIED ACTUARY.—The 

17 board of trustees of each association health plan which pro18 vides benefits options in addition to health insurance cov19 erage and which is applying for certification under this 

20 part or is certified under this part shall engage, on behalf 

21 of all participants and beneficiaries, a qualified actuary 

22 who shall be responsible for the preparation of the materials 

23 comprising information necessary to be submitted by a 

24 qualified actuary under this part. The qualified actuary 

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1 essary to enable such actuary to form an opinion as to 

2 whether the contents of the matters reported under this 

3 part— 

4 ‘‘(1) are in the aggregate reasonably related to 

5 the experience of the plan and to reasonable expecta6 tions; and 

7 ‘‘(2) represent such actuary’s best estimate of an8 ticipated experience under the plan. 

9 The opinion by the qualified actuary shall be made with 

10 respect to, and shall be made a part of, the annual report. 

11 ‘‘SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TER12 MINATION. 

13 ‘‘Except as provided in section 809(b), an association 

14 health plan which is or has been certified under this part 

15 may terminate (upon or at any time after cessation of ac16 cruals in benefit liabilities) only if the board of trustees, 

17 not less than 60 days before the proposed termination 

18 date— 

19 ‘‘(1) provides to the participants and bene20 ficiaries a written notice of intent to terminate stat21 ing that such termination is intended and the pro22 posed termination date; 

23 ‘‘(2) develops a plan for winding up the affairs 

24 of the plan in connection with such termination in a 

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1 manner which will result in timely payment of all 

2 benefits for which the plan is obligated; and 

3 ‘‘(3) submits such plan in writing to the appli4 cable authority. 

5 Actions required under this section shall be taken in such 

6 form and manner as may be prescribed by the applicable 

7 authority by regulation. 

8 ‘‘SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMI9 NATION. 

10 ‘‘(a) ACTIONS TO AVOID DEPLETION OF RESERVES.— 

11 An association health plan which is certified under this 

12 part and which provides benefits other than health insur13 ance coverage shall continue to meet the requirements of sec14 tion 806, irrespective of whether such certification continues 

15 in effect. The board of trustees of such plan shall determine 

16 quarterly whether the requirements of section 806 are met. 

17 In any case in which the board determines that there is 

18 reason to believe that there is or will be a failure to meet 

19 such requirements, or the applicable authority makes such 

20 a determination and so notifies the board, the board shall 

21 immediately notify the qualified actuary engaged by the 

22 plan, and such actuary shall, not later than the end of the 

23 next following month, make such recommendations to the 

24 board for corrective action as the actuary determines nec25 essary to ensure compliance with section 806. Not later than 

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1 30 days after receiving from the actuary recommendations 

2 for corrective actions, the board shall notify the applicable 

3 authority (in such form and manner as the applicable au4 thority may prescribe by regulation) of such recommenda5 tions of the actuary for corrective action, together with a 

6 description of the actions (if any) that the board has taken 

7 or plans to take in response to such recommendations. The 

8 board shall thereafter report to the applicable authority, in 

9 such form and frequency as the applicable authority may 

10 specify to the board, regarding corrective action taken by 

11 the board until the requirements of section 806 are met. 

12 ‘‘(b) MANDATORY TERMINATION.—In any case in 

13 which— 

14 ‘‘(1) the applicable authority has been notified 

15 under subsection (a) (or by an issuer of excess/stop 

16 loss insurance or indemnity insurance pursuant to 

17 section 806(a)) of a failure of an association health 

18 plan which is or has been certified under this part 

19 and is described in section 806(a)(2) to meet the re20 quirements of section 806 and has not been notified 

21 by the board of trustees of the plan that corrective ac22 tion has restored compliance with such requirements; 

23 and 

24 ‘‘(2) the applicable authority determines that 

25 there is a reasonable expectation that the plan will 

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1 continue to fail to meet the requirements of section 

2 806, 

3 the board of trustees of the plan shall, at the direction of 

4 the applicable authority, terminate the plan and, in the 

5 course of the termination, take such actions as the applica6 ble authority may require, including satisfying any claims 

7 referred to in section 806(a)(2)(B)(iii) and recovering for 

8 the plan any liability under subsection (a)(2)(B)(iii) or (e) 

9 of section 806, as necessary to ensure that the affairs of the 

10 plan will be, to the maximum extent possible, wound up 

11 in a manner which will result in timely provision of all 

12 benefits for which the plan is obligated. 

13 ‘‘SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOL14 VENT ASSOCIATION HEALTH PLANS PRO15 VIDING HEALTH BENEFITS IN ADDITION TO 

16 HEALTH INSURANCE COVERAGE. 

17 ‘‘(a) APPOINTMENT OF SECRETARY AS TRUSTEE FOR

18 INSOLVENT PLANS.—Whenever the Secretary determines 

19 that an association health plan which is or has been cer20 tified under this part and which is described in section 

21 806(a)(2) will be unable to provide benefits when due or 

22 is otherwise in a financially hazardous condition, as shall 

23 be defined by the Secretary by regulation, the Secretary 

24 shall, upon notice to the plan, apply to the appropriate 

25 United States district court for appointment of the Secmstockstill on DSK30JT082PROD with BILLS

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1 retary as trustee to administer the plan for the duration 

2 of the insolvency. The plan may appear as a party and 

3 other interested persons may intervene in the proceedings 

4 at the discretion of the court. The court shall appoint such 

5 Secretary trustee if the court determines that the trusteeship 

6 is necessary to protect the interests of the participants and 

7 beneficiaries or providers of medical care or to avoid any 

8 unreasonable deterioration of the financial condition of the 

9 plan. The trusteeship of such Secretary shall continue until 

10 the conditions described in the first sentence of this sub11 section are remedied or the plan is terminated. 

12 ‘‘(b) POWERS AS TRUSTEE.—The Secretary, upon ap13 pointment as trustee under subsection (a), shall have the 

14 power— 

15 ‘‘(1) to do any act authorized by the plan, this 

16 title, or other applicable provisions of law to be done 

17 by the plan administrator or any trustee of the plan; 

18 ‘‘(2) to require the transfer of all (or any part) 

19 of the assets and records of the plan to the Secretary 

20 as trustee; 

21 ‘‘(3) to invest any assets of the plan which the 

22 Secretary holds in accordance with the provisions of 

23 the plan, regulations prescribed by the Secretary, and 

24 applicable provisions of law; 

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1 ‘‘(4) to require the sponsor, the plan adminis2 trator, any participating employer, and any em3 ployee organization representing plan participants to 

4 furnish any information with respect to the plan 

5 which the Secretary as trustee may reasonably need 

6 in order to administer the plan; 

7 ‘‘(5) to collect for the plan any amounts due the 

8 plan and to recover reasonable expenses of the trustee9 ship; 

10 ‘‘(6) to commence, prosecute, or defend on behalf 

11 of the plan any suit or proceeding involving the plan; 

12 ‘‘(7) to issue, publish, or file such notices, state13 ments, and reports as may be required by the Sec14 retary by regulation or required by any order of the 

15 court; 

16 ‘‘(8) to terminate the plan (or provide for its ter17 mination in accordance with section 809(b)) and liq18 uidate the plan assets, to restore the plan to the re19 sponsibility of the sponsor, or to continue the trustee20 ship; 

21 ‘‘(9) to provide for the enrollment of plan par22 ticipants and beneficiaries under appropriate cov23 erage options; and 

24 ‘‘(10) to do such other acts as may be necessary 

25 to comply with this title or any order of the court and 

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1 to protect the interests of plan participants and bene2 ficiaries and providers of medical care. 

3 ‘‘(c) NOTICE OF APPOINTMENT.—As soon as prac4 ticable after the Secretary’s appointment as trustee, the Sec5 retary shall give notice of such appointment to— 

6 ‘‘(1) the sponsor and plan administrator; 

7 ‘‘(2) each participant; 

8 ‘‘(3) each participating employer; and 

9 ‘‘(4) if applicable, each employee organization 

10 which, for purposes of collective bargaining, rep11 resents plan participants. 

12 ‘‘(d) ADDITIONAL DUTIES.—Except to the extent in13 consistent with the provisions of this title, or as may be 

14 otherwise ordered by the court, the Secretary, upon appoint15 ment as trustee under this section, shall be subject to the 

16 same duties as those of a trustee under section 704 of title 

17 11, United States Code, and shall have the duties of a fidu18 ciary for purposes of this title. 

19 ‘‘(e) OTHER PROCEEDINGS.—An application by the 

20 Secretary under this subsection may be filed notwith21 standing the pendency in the same or any other court of 

22 any bankruptcy, mortgage foreclosure, or equity receiver23 ship proceeding, or any proceeding to reorganize, conserve, 

24 or liquidate such plan or its property, or any proceeding 

25 to enforce a lien against property of the plan. 

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1 ‘‘(f) JURISDICTION OF COURT.— 

2 ‘‘(1) IN GENERAL.—Upon the filing of an appli3 cation for the appointment as trustee or the issuance 

4 of a decree under this section, the court to which the 

5 application is made shall have exclusive jurisdiction 

6 of the plan involved and its property wherever located 

7 with the powers, to the extent consistent with the pur8 poses of this section, of a court of the United States 

9 having jurisdiction over cases under chapter 11 of 

10 title 11, United States Code. Pending an adjudication 

11 under this section such court shall stay, and upon ap12 pointment by it of the Secretary as trustee, such court 

13 shall continue the stay of, any pending mortgage fore14 closure, equity receivership, or other proceeding to re15 organize, conserve, or liquidate the plan, the sponsor, 

16 or property of such plan or sponsor, and any other 

17 suit against any receiver, conservator, or trustee of 

18 the plan, the sponsor, or property of the plan or spon19 sor. Pending such adjudication and upon the ap20 pointment by it of the Secretary as trustee, the court 

21 may stay any proceeding to enforce a lien against 

22 property of the plan or the sponsor or any other suit 

23 against the plan or the sponsor. 

24 ‘‘(2) VENUE.—An action under this section may 

25 be brought in the judicial district where the sponsor 

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1 or the plan administrator resides or does business or 

2 where any asset of the plan is situated. A district 

3 court in which such action is brought may issue proc4 ess with respect to such action in any other judicial 

5 district. 

6 ‘‘(g) PERSONNEL.—In accordance with regulations 

7 which shall be prescribed by the Secretary, the Secretary 

8 shall appoint, retain, and compensate accountants, actu9 aries, and other professional service personnel as may be 

10 necessary in connection with the Secretary’s service as 

11 trustee under this section. 

12 ‘‘SEC. 811. STATE ASSESSMENT AUTHORITY. 

13 ‘‘(a) IN GENERAL.—Notwithstanding section 514, a 

14 State may impose by law a contribution tax on an associa15 tion health plan described in section 806(a)(2), if the plan 

16 commenced operations in such State after the date of the 

17 enactment of the Small Business Health Fairness Act of 

18 2017. 

19 ‘‘(b) CONTRIBUTION TAX.—For purposes of this sec20 tion, the term ‘contribution tax’ imposed by a State on an 

21 association health plan means any tax imposed by such 

22 State if— 

23 ‘‘(1) such tax is computed by applying a rate to 

24 the amount of premiums or contributions, with re25 spect to individuals covered under the plan who are 

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1 residents of such State, which are received by the plan 

2 from participating employers located in such State or 

3 from such individuals; 

4 ‘‘(2) the rate of such tax does not exceed the rate 

5 of any tax imposed by such State on premiums or 

6 contributions received by insurers or health mainte7 nance organizations for health insurance coverage of8 fered in such State in connection with a group health 

9 plan; 

10 ‘‘(3) such tax is otherwise nondiscriminatory; 

11 and 

12 ‘‘(4) the amount of any such tax assessed on the 

13 plan is reduced by the amount of any tax or assess14 ment otherwise imposed by the State on premiums, 

15 contributions, or both received by insurers or health 

16 maintenance organizations for health insurance cov17 erage, aggregate excess/stop loss insurance (as defined 

18 in section 806(g)(1)), specific excess/stop loss insur19 ance (as defined in section 806(g)(2)), other insurance 

20 related to the provision of medical care under the 

21 plan, or any combination thereof provided by such in22 surers or health maintenance organizations in such 

23 State in connection with such plan. 

24 ‘‘SEC. 812. DEFINITIONS AND RULES OF CONSTRUCTION. 

25 ‘‘(a) DEFINITIONS.—For purposes of this part— 

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1 ‘‘(1) GROUP HEALTH PLAN.—The term ‘group 

2 health plan’ has the meaning provided in section 

3 733(a)(1) (after applying subsection (b) of this sec4 tion). 

5 ‘‘(2) MEDICAL CARE.—The term ‘medical care’ 

6 has the meaning provided in section 733(a)(2). 

7 ‘‘(3) HEALTH INSURANCE COVERAGE.—The term 

8 ‘health insurance coverage’ has the meaning provided 

9 in section 733(b)(1). 

10 ‘‘(4) HEALTH INSURANCE ISSUER.—The term 

11 ‘health insurance issuer’ has the meaning provided in 

12 section 733(b)(2). 

13 ‘‘(5) APPLICABLE AUTHORITY.—The term ‘appli14 cable authority’ means the Secretary, except that, in 

15 connection with any exercise of the Secretary’s au16 thority regarding which the Secretary is required 

17 under section 506(d) to consult with a State, such 

18 term means the Secretary, in consultation with such 

19 State. 

20 ‘‘(6) HEALTH STATUS-RELATED FACTOR.—The 

21 term ‘health status-related factor’ has the meaning 

22 provided in section 733(d)(2). 

23 ‘‘(7) INDIVIDUAL MARKET.— 

24 ‘‘(A) IN GENERAL.—The term ‘individual 

25 market’ means the market for health insurance 

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1 coverage offered to individuals other than in con2 nection with a group health plan. 

3 ‘‘(B) TREATMENT OF VERY SMALL

4 GROUPS.— 

5 ‘‘(i) IN GENERAL.—Subject to clause 

6 (ii), such term includes coverage offered in 

7 connection with a group health plan that 

8 has fewer than 2 participants as current 

9 employees or participants described in sec10 tion 732(d)(3) on the first day of the plan 

11 year. 

12 ‘‘(ii) STATE EXCEPTION.—Clause (i) 

13 shall not apply in the case of health insur14 ance coverage offered in a State if such 

15 State regulates the coverage described in 

16 such clause in the same manner and to the 

17 same extent as coverage in the small group 

18 market (as defined in section 2791(e)(5) of 

19 the Public Health Service Act) is regulated 

20 by such State. 

21 ‘‘(8) PARTICIPATING EMPLOYER.—The term ‘par22 ticipating employer’ means, in connection with an as23 sociation health plan, any employer, if any indi24 vidual who is an employee of such employer, a part25 ner in such employer, or a self-employed individual 

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1 who is such employer (or any dependent, as defined 

2 under the terms of the plan, of such individual) is or 

3 was covered under such plan in connection with the 

4 status of such individual as such an employee, part5 ner, or self-employed individual in relation to the 

6 plan. 

7 ‘‘(9) APPLICABLE STATE AUTHORITY.—The term 

8 ‘applicable State authority’ means, with respect to a 

9 health insurance issuer in a State, the State insur10 ance commissioner or official or officials designated 

11 by the State to enforce the requirements of title XXVII 

12 of the Public Health Service Act for the State involved 

13 with respect to such issuer. 

14 ‘‘(10) QUALIFIED ACTUARY.—The term ‘qualified 

15 actuary’ means an individual who is a member of the 

16 American Academy of Actuaries. 

17 ‘‘(11) AFFILIATED MEMBER.—The term ‘affili18 ated member’ means, in connection with a sponsor— 

19 ‘‘(A) a person who is otherwise eligible to be 

20 a member of the sponsor but who elects an affili21 ated status with the sponsor, 

22 ‘‘(B) in the case of a sponsor with members 

23 which consist of associations, a person who is a 

24 member of any such association and elects an af25 filiated status with the sponsor, or 

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1 ‘‘(C) in the case of an association health 

2 plan in existence on the date of the enactment of 

3 the Small Business Health Fairness Act of 2017, 

4 a person eligible to be a member of the sponsor 

5 or one of its member associations. 

6 ‘‘(12) LARGE EMPLOYER.—The term ‘large em7 ployer’ means, in connection with a group health 

8 plan with respect to a plan year, an employer who 

9 employed an average of at least 51 employees on busi10 ness days during the preceding calendar year and 

11 who employs at least 2 employees on the first day of 

12 the plan year. 

13 ‘‘(13) SMALL EMPLOYER.—The term ‘small em14 ployer’ means, in connection with a group health 

15 plan with respect to a plan year, an employer who 

16 is not a large employer. 

17 ‘‘(b) RULES OF CONSTRUCTION.— 

18 ‘‘(1) EMPLOYERS AND EMPLOYEES.—For pur19 poses of determining whether a plan, fund, or pro20 gram is an employee welfare benefit plan which is an 

21 association health plan, and for purposes of applying 

22 this title in connection with such plan, fund, or pro23 gram so determined to be such an employee welfare 

24 benefit plan— 

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1 ‘‘(A) in the case of a partnership, the term 

2 ‘employer’ (as defined in section 3(5)) includes 

3 the partnership in relation to the partners, and 

4 the term ‘employee’ (as defined in section 3(6)) 

5 includes any partner in relation to the partner6 ship; and 

7 ‘‘(B) in the case of a self-employed indi8 vidual, the term ‘employer’ (as defined in section 

9 3(5)) and the term ‘employee’ (as defined in sec10 tion 3(6)) shall include such individual. 

11 ‘‘(2) PLANS, FUNDS, AND PROGRAMS TREATED AS

12 EMPLOYEE WELFARE BENEFIT PLANS.—In the case of 

13 any plan, fund, or program which was established or 

14 is maintained for the purpose of providing medical 

15 care (through the purchase of insurance or otherwise) 

16 for employees (or their dependents) covered thereunder 

17 and which demonstrates to the Secretary that all re18 quirements for certification under this part would be 

19 met with respect to such plan, fund, or program if 

20 such plan, fund, or program were a group health 

21 plan, such plan, fund, or program shall be treated for 

22 purposes of this title as an employee welfare benefit 

23 plan on and after the date of such demonstration.’’. 

24 (b) CONFORMING AMENDMENTS TO PREEMPTION

25 RULES.— 

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1 (1) Section 514(b)(6) of such Act (29 U.S.C. 

2 1144(b)(6)) is amended by adding at the end the fol3 lowing new subparagraph: 

4 ‘‘(E) The preceding subparagraphs of this paragraph 

5 do not apply with respect to any State law in the case of 

6 an association health plan which is certified under part 8.’’. 

7 (2) Section 514 of such Act (29 U.S.C. 1144) is 

8 amended— 

9 (A) in subsection (b)(4), by striking ‘‘Sub10 section (a)’’ and inserting ‘‘Subsections (a) and 

11 (f)’’; 

12 (B) in subsection (b)(5), by striking ‘‘sub13 section (a)’’ in subparagraph (A) and inserting 

14 ‘‘subsection (a) of this section and subsections 

15 (a)(2)(B) and (b) of section 805’’, and by strik16 ing ‘‘subsection (a)’’ in subparagraph (B) and 

17 inserting ‘‘subsection (a) of this section or sub18 section (a)(2)(B) or (b) of section 805’’; and 

19 (C) by adding at the end the following new 

20 subsection: 

21 ‘‘(f)(1) Except as provided in subsection (b)(4), the 

22 provisions of this title shall supersede any and all State 

23 laws insofar as they may now or hereafter preclude, or have 

24 the effect of precluding, a health insurance issuer from offermstockstill on DSK30JT082PROD with BILLS

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1 ing health insurance coverage in connection with an asso2 ciation health plan which is certified under part 8. 

3 ‘‘(2) Except as provided in paragraphs (4) and (5) of 

4 subsection (b) of this section— 

5 ‘‘(A) In any case in which health insurance cov6 erage of any policy type is offered under an associa7 tion health plan certified under part 8 to a partici8 pating employer operating in such State, the provi9 sions of this title shall supersede any and all laws of 

10 such State insofar as they may preclude a health in11 surance issuer from offering health insurance coverage 

12 of the same policy type to other employers operating 

13 in the State which are eligible for coverage under such 

14 association health plan, whether or not such other em15 ployers are participating employers in such plan. 

16 ‘‘(B) In any case in which health insurance cov17 erage of any policy type is offered in a State under 

18 an association health plan certified under part 8 and 

19 the filing, with the applicable State authority (as de20 fined in section 812(a)(9)), of the policy form in con21 nection with such policy type is approved by such 

22 State authority, the provisions of this title shall su23 persede any and all laws of any other State in which 

24 health insurance coverage of such type is offered, inso25 far as they may preclude, upon the filing in the same 

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1 form and manner of such policy form with the appli2 cable State authority in such other State, the ap3 proval of the filing in such other State. 

4 ‘‘(3) Nothing in subsection (b)(6)(E) or the preceding 

5 provisions of this subsection shall be construed, with respect 

6 to health insurance issuers or health insurance coverage, to 

7 supersede or impair the law of any State— 

8 ‘‘(A) providing solvency standards or similar 

9 standards regarding the adequacy of insurer capital, 

10 surplus, reserves, or contributions, or 

11 ‘‘(B) relating to prompt payment of claims. 

12 ‘‘(4) For additional provisions relating to association 

13 health plans, see subsections (a)(2)(B) and (b) of section 

14 805. 

15 ‘‘(5) For purposes of this subsection, the term ‘associa16 tion health plan’ has the meaning provided in section 

17 801(a), and the terms ‘health insurance coverage’, ‘partici18 pating employer’, and ‘health insurance issuer’ have the 

19 meanings provided such terms in section 812, respectively.’’. 

20 (3) Section 514(b)(6)(A) of such Act (29 U.S.C. 

21 1144(b)(6)(A)) is amended— 

22 (A) in clause (i)(II), by striking ‘‘and’’ at 

23 the end; 

24 (B) in clause (ii), by inserting ‘‘and which 

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1 ing of section 733(a)(2)),’’ after ‘‘arrangement,’’, 

2 and by striking ‘‘title.’’ and inserting ‘‘title, 

3 and’’; and 

4 (C) by adding at the end the following new 

5 clause: 

6 ‘‘(iii) subject to subparagraph (E), in the case of 

7 any other employee welfare benefit plan which is a 

8 multiple employer welfare arrangement and which 

9 provides medical care (within the meaning of section 

10 733(a)(2)), any law of any State which regulates in11 surance may apply.’’. 

12 (4) Section 514(d) of such Act (29 U.S.C. 

13 1144(d)) is amended— 

14 (A) by striking ‘‘Nothing’’ and inserting 

15 ‘‘(1) Except as provided in paragraph (2), noth16 ing’’; and 

17 (B) by adding at the end the following new 

18 paragraph: 

19 ‘‘(2) Nothing in any other provision of law enacted 

20 on or after the date of the enactment of the Small Business 

21 Health Fairness Act of 2017 shall be construed to alter, 

22 amend, modify, invalidate, impair, or supersede any provi23 sion of this title, except by specific cross-reference to the af24 fected section.’’. 

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1 (c) PLAN SPONSOR.—Section 3(16)(B) of such Act (29 

2 U.S.C. 102(16)(B)) is amended by adding at the end the 

3 following new sentence: ‘‘Such term also includes a person 

4 serving as the sponsor of an association health plan under 

5 part 8.’’. 

6 (d) DISCLOSURE OF SOLVENCY PROTECTIONS RE7 LATED TO SELF-INSURED AND FULLY INSURED OPTIONS

8 UNDER ASSOCIATION HEALTH PLANS.—Section 102(b) of 

9 such Act (29 U.S.C. 102(b)) is amended by adding at the 

10 end the following: ‘‘An association health plan shall include 

11 in its summary plan description, in connection with each 

12 benefit option, a description of the form of solvency or guar13 antee fund protection secured pursuant to this Act or appli14 cable State law, if any.’’. 

15 (e) SAVINGS CLAUSE.—Section 731(c) of such Act is 

16 amended by inserting ‘‘or part 8’’ after ‘‘this part’’. 

17 (f) REPORT TO THE CONGRESS REGARDING CERTIFI18 CATION OF SELF-INSURED ASSOCIATION HEALTH PLANS.— 

19 Not later than January 1, 2022, the Secretary of Labor 

20 shall report to the Committee on Education and the Work21 force of the House of Representatives and the Committee 

22 on Health, Education, Labor, and Pensions of the Senate 

23 the effect association health plans have had, if any, on re24 ducing the number of uninsured individuals. 

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1 (g) CLERICAL AMENDMENT.—The table of contents in 

2 section 1 of the Employee Retirement Income Security Act 

3 of 1974 is amended by inserting after the item relating to 

4 section 734 the following new items: 

‘‘PART 8. RULES GOVERNING ASSOCIATION HEALTH PLANS

‘‘801. Association health plans. 

‘‘802. Certification of association health plans. 

‘‘803. Requirements relating to sponsors and boards of trustees. 

‘‘804. Participation and coverage requirements. 

‘‘805. Other requirements relating to plan documents, contribution rates, and benefit options. 

‘‘806. Maintenance of reserves and provisions for solvency for plans providing 

health benefits in addition to health insurance coverage. 

‘‘807. Requirements for application and related requirements. 

‘‘808. Notice requirements for voluntary termination. 

‘‘809. Corrective actions and mandatory termination. 

‘‘810. Trusteeship by the Secretary of insolvent association health plans providing 

health benefits in addition to health insurance coverage. 

‘‘811. State assessment authority. 

‘‘812. Definitions and rules of construction.’’. 

5 SEC. 3. CLARIFICATION OF TREATMENT OF SINGLE EM6 PLOYER ARRANGEMENTS. 

7 Section 3(40)(B) of the Employee Retirement Income 

8 Security Act of 1974 (29 U.S.C. 1002(40)(B)) is amended— 

9 (1) in clause (i), by inserting after ‘‘control 

10 group,’’ the following: ‘‘except that, in any case in 

11 which the benefit referred to in subparagraph (A) con12 sists of medical care (as defined in section 812(a)(2)), 

13 two or more trades or businesses, whether or not in14 corporated, shall be deemed a single employer for any 

15 plan year of such plan, or any fiscal year of such 

16 other arrangement, if such trades or businesses are 

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1 within the same control group during such year or at 

2 any time during the preceding 1-year period,’’; 

3 (2) in clause (iii), by striking ‘‘(iii) the deter4 mination’’ and inserting the following: 

5 ‘‘(iii)(I) in any case in which the benefit referred 

6 to in subparagraph (A) consists of medical care (as 

7 defined in section 812(a)(2)), the determination of 

8 whether a trade or business is under ‘common control’ 

9 with another trade or business shall be determined 

10 under regulations of the Secretary applying prin11 ciples consistent and coextensive with the principles 

12 applied in determining whether employees of two or 

13 more trades or businesses are treated as employed by 

14 a single employer under section 4001(b), except that, 

15 for purposes of this paragraph, an interest of greater 

16 than 25 percent may not be required as the minimum 

17 interest necessary for common control, or 

18 ‘‘(II) in any other case, the determination’’; 

19 (3) by redesignating clauses (iv) and (v) as 

20 clauses (v) and (vi), respectively; and 

21 (4) by inserting after clause (iii) the following 

22 new clause: 

23 ‘‘(iv) in any case in which the benefit referred to 

24 in subparagraph (A) consists of medical care (as de25 fined in section 812(a)(2)), in determining, after the 

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1 application of clause (i), whether benefits are pro2 vided to employees of two or more employers, the ar3 rangement shall be treated as having only one par4 ticipating employer if, after the application of clause 

5 (i), the number of individuals who are employees and 

6 former employees of any one participating employer 

7 and who are covered under the arrangement is greater 

8 than 75 percent of the aggregate number of all indi9 viduals who are employees or former employees of 

10 participating employers and who are covered under 

11 the arrangement,’’. 

12 SEC. 4. ENFORCEMENT PROVISIONS RELATING TO ASSO13 CIATION HEALTH PLANS. 

14 (a) CRIMINAL PENALTIES FOR CERTAIN WILLFUL

15 MISREPRESENTATIONS.—Section 501 of the Employee Re16 tirement Income Security Act of 1974 (29 U.S.C. 1131) is 

17 amended by adding at the end the following new subsection: 

18 ‘‘(c) Any person who willfully falsely represents, to any 

19 employee, any employee’s beneficiary, any employer, the 

20 Secretary, or any State, a plan or other arrangement estab21 lished or maintained for the purpose of offering or pro22 viding any benefit described in section 3(1) to employees 

23 or their beneficiaries as— 

24 ‘‘(1) being an association health plan which has 

25 been certified under part 8; 

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1 ‘‘(2) having been established or maintained 

2 under or pursuant to one or more collective bar3 gaining agreements which are reached pursuant to 

4 collective bargaining described in section 8(d) of the 

5 National Labor Relations Act (29 U.S.C. 158(d)) or 

6 paragraph Fourth of section 2 of the Railway Labor 

7 Act (45 U.S.C. 152, paragraph Fourth) or which are 

8 reached pursuant to labor-management negotiations 

9 under similar provisions of State public employee re10 lations laws; or 

11 ‘‘(3) being a plan or arrangement described in 

12 section 3(40)(A)(i), 

13 shall, upon conviction, be imprisoned not more than 5 

14 years, be fined under title 18, United States Code, or both.’’. 

15 (b) CEASE ACTIVITIES ORDERS.—Section 502 of the 

16 Employee Retirement Income Security Act of 1974 (29 

17 U.S.C. 1132) is amended by adding at the end the following 

18 new subsection: 

19 ‘‘(n) ASSOCIATION HEALTH PLAN CEASE AND DESIST

20 ORDERS.— 

21 ‘‘(1) IN GENERAL.—Subject to paragraph (2), 

22 upon application by the Secretary showing the oper23 ation, promotion, or marketing of an association 

24 health plan (or similar arrangement providing benemstockstill on DSK30JT082PROD with BILLS

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1 fits consisting of medical care (as defined in section 

2 733(a)(2))) that— 

3 ‘‘(A) is not certified under part 8, is subject 

4 under section 514(b)(6) to the insurance laws of 

5 any State in which the plan or arrangement of6 fers or provides benefits, and is not licensed, reg7 istered, or otherwise approved under the insur8 ance laws of such State; or 

9 ‘‘(B) is an association health plan certified 

10 under part 8 and is not operating in accordance 

11 with the requirements under part 8 for such cer12 tification, 

13 a district court of the United States shall enter an 

14 order requiring that the plan or arrangement cease 

15 activities. 

16 ‘‘(2) EXCEPTION.—Paragraph (1) shall not 

17 apply in the case of an association health plan or 

18 other arrangement if the plan or arrangement shows 

19 that— 

20 ‘‘(A) all benefits under it referred to in 

21 paragraph (1) consist of health insurance cov22 erage; and 

23 ‘‘(B) with respect to each State in which the 

24 plan or arrangement offers or provides benefits, 

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1 ance with applicable State laws that are not su2 perseded under section 514. 

3 ‘‘(3) ADDITIONAL EQUITABLE RELIEF.—The 

4 court may grant such additional equitable relief, in5 cluding any relief available under this title, as it 

6 deems necessary to protect the interests of the public 

7 and of persons having claims for benefits against the 

8 plan.’’. 

9 (c) RESPONSIBILITY FOR CLAIMS PROCEDURE.—Sec10 tion 503 of the Employee Retirement Income Security Act 

11 of 1974 (29 U.S.C. 1133) is amended by inserting ‘‘(a) IN

12 GENERAL.—’’ before ‘‘In accordance’’, and by adding at the 

13 end the following new subsection: 

14 ‘‘(b) ASSOCIATION HEALTH PLANS.—The terms of each 

15 association health plan which is or has been certified under 

16 part 8 shall require the board of trustees or the named fidu17 ciary (as applicable) to ensure that the requirements of this 

18 section are met in connection with claims filed under the 

19 plan.’’. 

20 SEC. 5. COOPERATION BETWEEN FEDERAL AND STATE AU21 THORITIES. 

22 Section 506 of the Employee Retirement Income Secu23 rity Act of 1974 (29 U.S.C. 1136) is amended by adding 

24 at the end the following new subsection: 

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1 ‘‘(d) CONSULTATION WITH STATES WITH RESPECT TO

2 ASSOCIATION HEALTH PLANS.— 

3 ‘‘(1) AGREEMENTS WITH STATES.—The Sec4 retary shall consult with the State recognized under 

5 paragraph (2) with respect to an association health 

6 plan regarding the exercise of— 

7 ‘‘(A) the Secretary’s authority under sec8 tions 502 and 504 to enforce the requirements for 

9 certification under part 8; and 

10 ‘‘(B) the Secretary’s authority to certify as11 sociation health plans under part 8 in accord12 ance with regulations of the Secretary applicable 

13 to certification under part 8. 

14 ‘‘(2) RECOGNITION OF PRIMARY DOMICILE

15 STATE.—In carrying out paragraph (1), the Sec16 retary shall ensure that only one State will be recog17 nized, with respect to any particular association 

18 health plan, as the State with which consultation is 

19 required. In carrying out this paragraph— 

20 ‘‘(A) in the case of a plan which provides 

21 health insurance coverage (as defined in section 

22 812(a)(3)), such State shall be the State with 

23 which filing and approval of a policy type of24 fered by the plan was initially obtained, and 

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1 ‘‘(B) in any other case, the Secretary shall 

2 take into account the places of residence of the 

3 participants and beneficiaries under the plan 

4 and the State in which the trust is maintained.’’. 

5 SEC. 6. EFFECTIVE DATE AND TRANSITIONAL AND OTHER 

6 RULES. 

7 (a) EFFECTIVE DATE.—The amendments made by this 

8 Act shall take effect 1 year after the date of the enactment 

9 of this Act. The Secretary of Labor shall first issue all regu10 lations necessary to carry out the amendments made by this 

11 Act within 1 year after the date of the enactment of this 

12 Act. 

13 (b) TREATMENT OF CERTAIN EXISTING HEALTH BEN14 EFITS PROGRAMS.— 

15 (1) IN GENERAL.—In any case in which, as of 

16 the date of the enactment of this Act, an arrangement 

17 is maintained in a State for the purpose of providing 

18 benefits consisting of medical care for the employees 

19 and beneficiaries of its participating employers, at 

20 least 200 participating employers make contributions 

21 to such arrangement, such arrangement has been in 

22 existence for at least 10 years, and such arrangement 

23 is licensed under the laws of one or more States to 

24 provide such benefits to its participating employers, 

25 upon the filing with the applicable authority (as demstockstill on DSK30JT082PROD with BILLS

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1 fined in section 812(a)(5) of the Employee Retirement 

2 Income Security Act of 1974 (as amended by this sub3 title)) by the arrangement of an application for cer4 tification of the arrangement under part 8 of subtitle 

5 B of title I of such Act— 

6 (A) such arrangement shall be deemed to be 

7 a group health plan for purposes of title I of 

8 such Act; 

9 (B) the requirements of sections 801(a) and 

10 803(a) of the Employee Retirement Income Secu11 rity Act of 1974 shall be deemed met with respect 

12 to such arrangement; 

13 (C) the requirements of section 803(b) of 

14 such Act shall be deemed met, if the arrangement 

15 is operated by a board of directors which— 

16 (i) is elected by the participating em17 ployers, with each employer having one 

18 vote; and 

19 (ii) has complete fiscal control over the 

20 arrangement and which is responsible for 

21 all operations of the arrangement; 

22 (D) the requirements of section 804(a) of 

23 such Act shall be deemed met with respect to 

24 such arrangement; and 

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1 (E) the arrangement may be certified by 

2 any applicable authority with respect to its oper3 ations in any State only if it operates in such 

4 State on the date of certification. 

5 The provisions of this subsection shall cease to apply 

6 with respect to any such arrangement at such time 

7 after the date of the enactment of this Act as the ap8 plicable requirements of this subsection are not met 

9 with respect to such arrangement. 

10 (2) DEFINITIONS.—For purposes of this sub11 section, the terms ‘‘group health plan’’, ‘‘medical 

12 care’’, and ‘‘participating employer’’ shall have the 

13 meanings provided in section 812 of the Employee 

14 Retirement Income Security Act of 1974, except that 

15 the reference in paragraph (7) of such section to an 

16 ‘‘association health plan’’ shall be deemed a reference 

17 to an arrangement referred to in this subsection. 

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Union Calendar No. 23 

115TH CONGRESS 

1ST SESSION H. R. 1101 

[Report No. 115–43] 

A BILL 

To amend title I of the Employee Retirement Inwith respect to medical care for their employees. choice for entrepreneurs with small businesses come Security Act of 1974 to improve access and 

MARCH 17, 2017 

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

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