Self-Insurance Protection Act

Subjects: Health, Employee benefits and pensions, Health care costs and insurance


<html><body><pre>[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2813 Introduced in House (IH)]

&lt;DOC&gt;






118th CONGRESS
  1st Session
                                H. R. 2813

   To amend the Employee Retirement Income Security Act of 1974, the 
  Public Health Service Act, and the Internal Revenue Code of 1986 to 
   exclude from the definition of health insurance coverage certain 
medical stop-loss insurance obtained by certain plan sponsors of group 
                 health plans, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 25, 2023

   Mr. Good of Virginia (for himself and Mr. Walberg) introduced the 
 following bill; which was referred to the Committee on Education and 
    the Workforce, and in addition to the Committees on Energy and 
     Commerce, and Ways and Means, for a period to be subsequently 
   determined by the Speaker, in each case for consideration of such 
 provisions as fall within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To amend the Employee Retirement Income Security Act of 1974, the 
  Public Health Service Act, and the Internal Revenue Code of 1986 to 
   exclude from the definition of health insurance coverage certain 
medical stop-loss insurance obtained by certain plan sponsors of group 
                 health plans, 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 ``Self-Insurance Protection Act''.

SEC. 2. FINDINGS.

    Congress finds the following:
            (1) Small and large employers offer health benefit plan 
        coverage to employees in self-funded arrangements using company 
        assets or a fund, or by paying premiums to purchase fully-
        insured coverage from a health insurance company.
            (2) Employers that self-fund health benefit plans will 
        often purchase stop-loss insurance as a financial risk 
        management tool to protect against excess or unexpected 
        catastrophic health plan claims losses that arise above 
        projected costs paid out of company assets.
            (3) Stop-loss coverage insures the employer sponsoring the 
        health benefit plan against unforeseen health plan claims, does 
        not insure the employee health benefit plan itself, and does 
        not pay health care providers for medical services provided to 
        the employees.
            (4) Employer-sponsored health benefit plans are regulated 
        under the Employee Retirement Income Security Act of 1974, 
        however, States regulate the availability and the coverage 
        terms of stop-loss insurance coverage that employers purchase 
        to protect company assets and to protect a fund against excess 
        or unexpected claims losses.
            (5) Both large and small employers that choose to self-fund 
        must also be able to protect company assets or a fund against 
        excess or unexpected claims losses and States must reasonably 
        regulate stop-loss insurance to assure its availability to both 
        large and small employers.

SEC. 3. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY CERTAIN PLAN 
              SPONSORS OF GROUP HEALTH PLANS NOT INCLUDED UNDER THE 
              DEFINITION OF HEALTH INSURANCE COVERAGE.

    (a) ERISA.--Section 733(b)(1) of the Employee Retirement Income 
Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is amended by adding at 
the end the following sentence: ``Such term shall not include a stop-
loss policy obtained by a self-funded health plan or a plan sponsor of 
a group health plan that self-funds the health risks of its plan 
participants to reimburse the plan or sponsor for losses that the plan 
or sponsor incurs in providing health or medical benefits to such plan 
participants in excess of a predetermined level set forth in the stop-
loss policy obtained by such plan or sponsor.''.
    (b) PHSA.--Section 2791(b)(1) of the Public Health Service Act (42 
U.S.C. 300gg-91(b)(1)) is amended by adding at the end the following 
new sentence: ``Such term shall not include a stop-loss policy obtained 
by a self-funded health plan or a plan sponsor of a group health plan 
that self-funds the health risks of its plan participants to reimburse 
the plan or sponsor for losses that the plan or sponsor incurs in 
providing health or medical benefits to such plan participants in 
excess of a predetermined level set forth in the stop-loss policy 
obtained by such plan or sponsor.''.
    (c) IRC.--Section 9832(b)(1)(A) of the Internal Revenue Code of 
1986 is amended by adding at the end the following new sentence: ``Such 
term shall not include a stop-loss policy obtained by a self-funded 
health plan or a plan sponsor of a group health plan that self-funds 
the health risks of its plan participants to reimburse the plan or 
sponsor for losses that the plan or sponsor incurs in providing health 
or medical benefits to such plan participants in excess of a 
predetermined level set forth in the stop-loss policy obtained by such 
plan or sponsor.''.

SEC. 4. EFFECT ON OTHER LAWS.

    Section 514(b) of the Employee Retirement Income Security Act of 
1974 (29 U.S.C. 1144(b)) is amended by adding at the end the following:
    ``(10) The provisions of this title (including part 7 relating to 
group health plans) shall preempt State laws insofar as they may now or 
hereafter prevent an employee benefit plan that is a group health plan 
from insuring against the risk of excess or unexpected health plan 
claims losses.''.
                                 &lt;all&gt;
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