pants and beneficiaries, unless, for any plan year, 
such coverage remains unavailable to the plan de-
spite good faith efforts exercised by the plan to se-
cure such coverage. 
‘‘(b) SPONSORSHIP.—The sponsor of a group health 
plan is described in this subsection if such sponsor—
‘‘(1) is organized and maintained in good faith, 
with a constitution and bylaws specifically stating its 
purpose and providing for periodic meetings on at 
least an annual basis, as a bona fide trade associa-
tion, a bona fide industry association (including a 
rural electric cooperative association or a rural tele-
phone cooperative association), a bona fide profes-
sional association, or a bona fide chamber of com-
merce (or similar bona fide business association, in-
cluding a corporation or similar organization that 
operates on a cooperative basis (within the meaning 
of section 1381 of the Internal Revenue Code of 
1986)), for substantial purposes other than that of 
obtaining or providing medical care; 
‘‘(2) is established as a permanent entity which 
receives the active support of its members and col-
lects from its members on a periodic basis dues or 
payments necessary to maintain eligibility for mem-
bership in the sponsor; and
‘‘(3) does not condition membership, such dues 
or payments, or coverage under the plan on the 
basis of health status-related factors with respect to 
the employees of its members (or affiliated mem-
bers), or the dependents of such employees, and does 
not condition such dues or payments on the basis of 
group health plan participation. 
Any sponsor consisting of an association of entities which 
meet the requirements of paragraphs (1), (2), and (3) 
shall be deemed to be a sponsor described in this sub-
section. 
‘‘SEC. 
802. 
CERTIFICATION 
OF 
ASSOCIATION 
HEALTH 
PLANS. 
‘‘(a) IN GENERAL.—The applicable authority shall 
prescribe by regulation, through negotiated rulemaking, a 
procedure under which, subject to subsection (b), the ap-
plicable authority shall certify association health plans 
which apply for certification as meeting the requirements 
of this part. 
‘‘(b) STANDARDS.—Under the procedure prescribed 
pursuant to subsection (a), in the case of an association 
health plan that provides at least one benefit option which 
does not consist of health insurance coverage, the applica-
ble authority shall certify such plan as meeting the re-
quirements of this part only if the applicable authority is 
satisfied that—
‘‘(1) such certification—
‘‘(A) is administratively feasible; 
‘‘(B) is not adverse to the interests of the 
individuals covered under the plan; and 
‘‘(C) is protective of the rights and benefits 
of the individuals covered under the plan; and 
‘‘(2) the applicable requirements of this part 
are met (or, upon the date on which the plan is to 
commence operations, will be met) with respect to 
the plan. 
‘‘(c) REQUIREMENTS APPLICABLE
TO CERTIFIED 
PLANS.—An association health plan with respect to which 
certification under this part is in effect shall meet the ap-
plicable requirements of this part, effective on the date 
of certification (or, if later, on the date on which the plan 
is to commence operations). 
‘‘(d) REQUIREMENTS
FOR
CONTINUED
CERTIFI-
CATION.—The applicable authority may provide by regula-
tion, through negotiated rulemaking, for continued certifi-
cation of association health plans under this part. 
‘‘(e) CLASS CERTIFICATION FOR FULLY INSURED 
PLANS.—The applicable authority shall establish a class 
certification procedure for association health plans under
which all benefits consist of health insurance coverage. 
Under such procedure, the applicable authority shall pro-
vide for the granting of certification under this part to 
the plans in each class of such association health plans 
upon appropriate filing under such procedure in connec-
tion with plans in such class and payment of the pre-
scribed fee under section 807(a). 
‘‘(f) CERTIFICATION OF SELF-INSURED ASSOCIATION 
HEALTH PLANS.—An association health plan which offers 
one or more benefit options which do not consist of health 
insurance coverage may be certified under this part only 
if such plan consists of any of the following: 
‘‘(1) a plan which offered such coverage on the 
date of the enactment of the Small Business Access 
and Choice for Entrepreneurs Act of 2003, 
‘‘(2) a plan under which the sponsor does not 
restrict membership to one or more trades and busi-
nesses or industries and whose eligible participating 
employers represent a broad cross-section of trades 
and businesses or industries, or 
‘‘(3) a plan whose eligible participating employ-
ers represent one or more trades or businesses, or 
one or more industries, which have been indicated as 
having average or above-average health insurance 
risk or health claims experience by reason of State
rate filings, denials of coverage, proposed premium 
rate levels, and other means demonstrated by such 
plan in accordance with regulations which the Sec-
retary shall prescribe through negotiated rule-
making, including (but not limited to) the following: 
agriculture; automobile dealerships; barbering and 
cosmetology; child care; construction; dance, theat-
rical, and orchestra productions; disinfecting and 
pest control; eating and drinking establishments; 
fishing; hospitals; labor organizations; logging; man-
ufacturing (metals); mining; medical and dental 
practices; medical laboratories; sanitary services; 
transportation (local and freight); and warehousing. 
‘‘SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND 
BOARDS OF TRUSTEES. 
‘‘(a) SPONSOR.—The requirements of this subsection 
are met with respect to an association health plan if the 
sponsor has met (or is deemed under this part to have 
met) the requirements of section 801(b) for a continuous 
period of not less than 3 years ending with the date of 
the application for certification under this part. 
‘‘(b) BOARD OF TRUSTEES.—The requirements of 
this subsection are met with respect to an association 
health plan if the following requirements are met:
‘‘(1) FISCAL CONTROL.—The plan is operated, 
pursuant to a trust agreement, by a board of trust-
ees which has complete fiscal control over the plan 
and which is responsible for all operations of the 
plan. 
‘‘(2) RULES
OF
OPERATION
AND
FINANCIAL 
CONTROLS.—The board of trustees has in effect 
rules of operation and financial controls, based on a 
3-year plan of operation, adequate to carry out the 
terms of the plan and to meet all requirements of 
this title applicable to the plan. 
‘‘(3) RULES
GOVERNING
RELATIONSHIP
TO 
PARTICIPATING
EMPLOYERS
AND
TO
CONTRAC-
TORS.—
‘‘(A) IN GENERAL.—Except as provided in 
subparagraphs (B) and (C), the members of the 
board of trustees are individuals selected from 
individuals who are the owners, officers, direc-
tors, or employees of the participating employ-
ers or who are partners in the participating em-
ployers and actively participate in the business. 
‘‘(B) LIMITATION.—
‘‘(i) GENERAL RULE.—Except as pro-
vided in clauses (ii) and (iii), no such 
member is an owner, officer, director, or
employee of, or partner in, a contract ad-
ministrator or other service provider to the 
plan. 
‘‘(ii) LIMITED EXCEPTION FOR PRO-
VIDERS OF SERVICES SOLELY ON BEHALF 
OF THE SPONSOR.—Officers or employees 
of a sponsor which is a service provider 
(other than a contract administrator) to 
the plan may be members of the board if 
they constitute not more than 25 percent 
of the membership of the board and they 
do not provide services to the plan other 
than on behalf of the sponsor. 
‘‘(iii) TREATMENT OF PROVIDERS OF 
MEDICAL CARE.—In the case of a sponsor 
which is an association whose membership 
consists primarily of providers of medical 
care, clause (i) shall not apply in the case 
of any service provider described in sub-
paragraph (A) who is a provider of medical 
care under the plan. 
‘‘(C) CERTAIN
PLANS
EXCLUDED.—Sub-
paragraph (A) shall not apply to an association 
health plan which is in existence on the date of
the enactment of the Small Business Access 
and Choice for Entrepreneurs Act of 2003. 
‘‘(D) SOLE AUTHORITY.—The board has 
sole authority under the plan to approve appli-
cations for participation in the plan and to con-
tract with a service provider to administer the 
day-to-day affairs of the plan. 
‘‘(c) TREATMENT OF FRANCHISE NETWORKS.—In 
the case of a group health plan which is established and 
maintained by a franchiser for a franchise network con-
sisting of its franchisees—
‘‘(1) the requirements of subsection (a) and sec-
tion 801(a)(1) shall be deemed met if such require-
ments would otherwise be met if the franchiser were 
deemed to be the sponsor referred to in section 
801(b), such network were deemed to be an associa-
tion described in section 801(b), and each franchisee 
were deemed to be a member (of the association and 
the sponsor) referred to in section 801(b); and 
‘‘(2) the requirements of section 804(a)(1) shall 
be deemed met. 
The Secretary may by regulation, through negotiated rule-
making, define for purposes of this subsection the terms 
‘franchiser’, ‘franchise network’, and ‘franchisee’. 
‘‘(d) CERTAIN COLLECTIVELY BARGAINED PLANS.—
‘‘(1) IN
GENERAL.—In the case of a group 
health plan described in paragraph (2)—
‘‘(A) the requirements of subsection (a) 
and section 801(a)(1) shall be deemed met; 
‘‘(B) the joint board of trustees shall be 
deemed a board of trustees with respect to 
which the requirements of subsection (b) are 
met; and 
‘‘(C) the requirements of section 804 shall 
be deemed met. 
‘‘(2) REQUIREMENTS.—A group health plan is 
described in this paragraph if—
‘‘(A) the plan is a multiemployer plan; or 
‘‘(B) the plan is in existence on April 1, 
1997, and would be described in section 
3(40)(A)(i) but solely for the failure to meet 
the requirements of section 3(40)(C)(ii). 
‘‘SEC. 804. PARTICIPATION AND COVERAGE REQUIRE-
MENTS. 
‘‘(a) COVERED EMPLOYERS AND INDIVIDUALS.—The 
requirements of this subsection are met with respect to 
an association health plan if, under the terms of the 
plan—
‘‘(1) each participating employer must be—
‘‘(A) a member of the sponsor;
‘‘(B) the sponsor; or 
‘‘(C) an affiliated member of the sponsor 
with respect to which the requirements of sub-
section (b) are met; 
except that, in the case of a sponsor which is a pro-
fessional association or other individual-based asso-
ciation, if at least one of the officers, directors, or 
employees of an employer, or at least one of the in-
dividuals who are partners in an employer and who 
actively participates in the business, is a member or 
such an affiliated member of the sponsor, partici-
pating employers may also include such employer; 
and 
‘‘(2) all individuals commencing coverage under 
the plan after certification under this part must 
be—
‘‘(A) active or retired owners (including 
self-employed individuals), officers, directors, or 
employees of, or partners in, participating em-
ployers; or 
‘‘(B) the beneficiaries of individuals de-
scribed in subparagraph (A). 
‘‘(b) COVERAGE OF PREVIOUSLY UNINSURED EM-
PLOYEES.—In the case of an association health plan in 
existence on the date of the enactment of the Small Busi-
ness Access and Choice for Entrepreneurs Act of 2003, 
an affiliated member of the sponsor of the plan may be 
offered coverage under the plan as a participating em-
ployer only if—
‘‘(1) the affiliated member was an affiliated 
member on the date of certification under this part; 
or 
‘‘(2) during the 12-month period preceding the 
date of the offering of such coverage, the affiliated 
member has not maintained or contributed to a 
group health plan with respect to any of its employ-
ees who would otherwise be eligible to participate in 
such association health plan. 
‘‘(c) INDIVIDUAL MARKET UNAFFECTED.—The re-
quirements of this subsection are met with respect to an 
association health plan if, under the terms of the plan, 
no participating employer may provide health insurance 
coverage in the individual market for any employee not 
covered under the plan which is similar to the coverage 
contemporaneously provided to employees of the employer 
under the plan, if such exclusion of the employee from cov-
erage under the plan is based on a health status-related 
factor with respect to the employee and such employee 
would, but for such exclusion on such basis, be eligible 
for coverage under the plan.
‘‘(d) PROHIBITION
OF DISCRIMINATION AGAINST 
EMPLOYERS
AND EMPLOYEES ELIGIBLE TO PARTICI-
PATE.—The requirements of this subsection are met with 
respect to an association health plan if—
‘‘(1) under the terms of the plan, all employers 
meeting the preceding requirements of this section 
are eligible to qualify as participating employers for 
all geographically available coverage options, unless, 
in the case of any such employer, participation or 
contribution requirements of the type referred to in 
section 2711 of the Public Health Service Act are 
not met; 
‘‘(2) upon request, any employer eligible to par-
ticipate is furnished information regarding all cov-
erage options available under the plan; and 
‘‘(3) the applicable requirements of sections 
701, 702, and 703 are met with respect to the plan. 
‘‘SEC. 805. OTHER REQUIREMENTS RELATING TO PLAN 
DOCUMENTS, CONTRIBUTION RATES, AND 
BENEFIT OPTIONS. 
‘‘(a) IN GENERAL.—The requirements of this section 
are met with respect to an association health plan if the 
following requirements are met: 
‘‘(1) 
CONTENTS
OF
GOVERNING
INSTRU-
MENTS.—The instruments governing the plan in-
clude a written instrument, meeting the require-
ments of an instrument required under section 
402(a)(1), which—
‘‘(A) provides that the board of trustees 
serves as the named fiduciary required for plans 
under section 402(a)(1) and serves in the ca-
pacity of a plan administrator (referred to in 
section 3(16)(A)); 
‘‘(B) provides that the sponsor of the plan 
is to serve as plan sponsor (referred to in sec-
tion 3(16)(B)); and 
‘‘(C) incorporates the requirements of sec-
tion 806. 
‘‘(2) CONTRIBUTION
RATES
MUST
BE
NON-
DISCRIMINATORY.—
‘‘(A) The contribution rates for any par-
ticipating small employer do not vary on the 
basis of the claims experience of such employer 
and do not vary on the basis of the type of 
business or industry in which such employer is 
engaged. 
‘‘(B) Nothing in this title or any other pro-
vision of law shall be construed to preclude an 
association health plan, or a health insurance 
issuer offering health insurance coverage in
connection with an association health plan, 
from—
‘‘(i) setting contribution rates based 
on the claims experience of the plan; or 
‘‘(ii) varying contribution rates for 
small employers in a State to the extent 
that such rates could vary using the same 
methodology employed in such State for 
regulating premium rates in the small 
group market with respect to health insur-
ance coverage offered in connection with 
bona fide associations (within the meaning 
of section 2791(d)(3) of the Public Health 
Service Act), 
subject to the requirements of section 702(b) 
relating to contribution rates. 
‘‘(3) FLOOR FOR NUMBER OF COVERED INDI-
VIDUALS
WITH
RESPECT
TO
CERTAIN
PLANS.—If 
any benefit option under the plan does not consist 
of health insurance coverage, the plan has as of the 
beginning of the plan year not fewer than 1,000 par-
ticipants and beneficiaries. 
‘‘(4) MARKETING REQUIREMENTS.—
‘‘(A) IN
GENERAL.—If a benefit option 
which consists of health insurance coverage is
offered under the plan, State-licensed insurance 
agents shall be used to distribute to small em-
ployers coverage which does not consist of 
health insurance coverage in a manner com-
parable to the manner in which such agents are 
used to distribute health insurance coverage. 
‘‘(B) 
STATE-LICENSED
INSURANCE 
AGENTS.—For purposes of subparagraph (A), 
the term ‘State-licensed insurance agents’ 
means one or more agents who are licensed in 
a State and are subject to the laws of such 
State relating to licensure, qualification, test-
ing, examination, and continuing education of 
persons authorized to offer, sell, or solicit 
health insurance coverage in such State. 
‘‘(5) 
REGULATORY
REQUIREMENTS.—Such 
other requirements as the applicable authority deter-
mines are necessary to carry out the purposes of this 
part, which shall be prescribed by the applicable au-
thority by regulation through negotiated rulemaking. 
‘‘(b) HEALTH BENEFIT OPTIONS UNDER AN ASSO-
CIATION HEALTH PLAN.—
‘‘(1) EXAMPLES OF TYPES OF COVERAGE.—The 
health benefits coverage made available through an 
association health plan may include, but is not lim-
ited to, any of the following if it meets the other ap-
plicable requirements of this title: 
‘‘(A) Coverage through a health mainte-
nance organization. 
‘‘(B) Coverage in connection with a pre-
ferred provider organization. 
‘‘(C) Coverage in connection with a li-
censed provider-sponsored organization. 
‘‘(D) Indemnity coverage through an insur-
ance company. 
‘‘(E) Coverage offered in connection with a 
contribution into a medical savings account or 
flexible spending account. 
‘‘(F) Coverage that includes a point-of-
service option. 
‘‘(G) Any combination of such types of 
coverage. 
‘‘(2) 
HEALTH
INSURANCE
COVERAGE
OP-
TIONS.—
‘‘(A) IN GENERAL.—An association health 
plan shall include a minimum of 4 health insur-
ance coverage options. At least 1 option shall be 
a non network option. At least 2 options shall 
meet all applicable State benefit mandates.
‘‘(B) MODEL
BENEFITS
PACKAGE.—The 
Secretary in consultation with the National As-
sociation of Insurance Commissioners shall de-
velop a model benefits package for health insur-
ance coverage not later than one year after the 
date of the enactment of the Consensus Health 
Care Access and Choice Act of 2003. 
‘‘(C) EXCEPTION TO GENERAL RULE.—An 
association health plan may offer 2 options that 
meet the requirements of the model benefits 
package in lieu of the State benefit mandate of-
ferings required under subparagraph (A). 
‘‘(3) PERMITTING ASSOCIATION HEALTH PLANS 
TO ADJUST DISTRIBUTIONS AMONG ISSUERS TO RE-
FLECT RELATIVE RISK OF ENROLLEES.—Nothing in 
this section shall be construed as precluding an asso-
ciation health plan from providing for adjustments 
in amounts distributed among the health insurance 
issuers offering health benefits coverage through the 
association health plan based on factors such as the 
relative health care risk of members enrolled under 
the coverage offered by the different issuers. 
‘‘(4) CONSTRUCTION.—Except as provided in 
subparagraph (2), nothing in this part or any provi-
sion of State law (as defined in section 514(c)(1))
shall be construed to preclude an association health 
plan, or a health insurance issuer offering health in-
surance coverage in connection with an association 
health plan, from exercising its sole discretion in se-
lecting the specific items and services consisting of 
medical care to be included as benefits under such 
plan or coverage, except (subject to section 514) in 
the case of any law to the extent that it (1) prohibits 
an exclusion of a specific disease from such cov-
erage, or (2) is not preempted under section 
731(a)(1) with respect to matters governed by sec-
tion 711 or 712. 
‘‘SEC. 806. MAINTENANCE OF RESERVES AND PROVISIONS 
FOR 
SOLVENCY 
FOR 
PLANS 
PROVIDING 
HEALTH BENEFITS IN ADDITION TO HEALTH 
INSURANCE COVERAGE. 
‘‘(a) IN GENERAL.—The requirements of this section 
are met with respect to an association health plan if—
‘‘(1) the benefits under the plan consist solely 
of health insurance coverage; or 
‘‘(2) if the plan provides any additional benefit 
options which do not consist of health insurance cov-
erage, the plan—
‘‘(A) establishes and maintains reserves 
with respect to such additional benefit options,
in amounts recommended by the qualified actu-
ary, consisting of—
‘‘(i) a reserve sufficient for unearned 
contributions; 
‘‘(ii) a reserve sufficient for benefit li-
abilities which have been incurred, which 
have not been satisfied, and for which risk 
of loss has not yet been transferred, and 
for expected administrative costs with re-
spect to such benefit liabilities; 
‘‘(iii) a reserve sufficient for any other 
obligations of the plan; and 
‘‘(iv) a reserve sufficient for a margin 
of error and other fluctuations, taking into 
account the specific circumstances of the 
plan; and 
‘‘(B) establishes and maintains aggregate 
and specific excess /stop loss insurance and sol-
vency indemnification, with respect to such ad-
ditional benefit options for which risk of loss 
has not yet been transferred, as follows: 
‘‘(i) The plan shall secure aggregate 
excess /stop loss insurance for the plan 
with an attachment point which is not 
greater than 125 percent of expected gross
annual claims. The applicable authority 
may by regulation, through negotiated 
rulemaking, provide for upward adjust-
ments in the amount of such percentage in 
specified circumstances in which the plan 
specifically provides for and maintains re-
serves in excess of the amounts required 
under subparagraph (A). 
‘‘(ii) The plan shall secure specific ex-
cess /stop loss insurance for the plan with 
an attachment point which is at least equal 
to an amount recommended by the plan’s 
qualified actuary (but not more than 
$175,000). The applicable authority may 
by regulation, through negotiated rule-
making, provide for adjustments in the 
amount of such insurance in specified cir-
cumstances in which the plan specifically 
provides for and maintains reserves in ex-
cess of the amounts required under sub-
paragraph (A). 
‘‘(iii) The plan shall secure indem-
nification insurance for any claims which 
the plan is unable to satisfy by reason of 
a plan termination.
Any regulations prescribed by the applicable authority 
pursuant to clause (i) or (ii) of subparagraph (B) may 
allow for such adjustments in the required levels of excess /
stop loss insurance as the qualified actuary may rec-
ommend, taking into account the specific circumstances 
of the plan. 
‘‘(b) MINIMUM SURPLUS IN ADDITION TO CLAIMS 
RESERVES.—In the case of any association health plan de-
scribed in subsection (a)(2), the requirements of this sub-
section are met if the plan establishes and maintains sur-
plus in an amount at least equal to—
‘‘(1) $500,000, or 
‘‘(2) such greater amount (but not greater than 
$2,000,000) as may be set forth in regulations pre-
scribed by the applicable authority through nego-
tiated rulemaking, based on the level of aggregate 
and specific excess /stop loss insurance provided with 
respect to such plan. 
‘‘(c) ADDITIONAL REQUIREMENTS.—In the case of 
any association health plan described in subsection (a)(2), 
the applicable authority may provide such additional re-
quirements relating to reserves and excess /stop loss insur-
ance as the applicable authority considers appropriate. 
Such requirements may be provided by regulation, through
negotiated rulemaking, with respect to any such plan or 
any class of such plans. 
‘‘(d) ADJUSTMENTS FOR EXCESS /STOP LOSS INSUR-
ANCE.—The applicable authority may provide for adjust-
ments to the levels of reserves otherwise required under 
subsections (a) and (b) with respect to any plan or class 
of plans to take into account excess /stop loss insurance 
provided with respect to such plan or plans.
‘‘(e) ALTERNATIVE MEANS OF COMPLIANCE.—The 
applicable authority may permit an association health plan 
described in subsection (a)(2) to substitute, for all or part 
of the requirements of this section (except subsection 
(a)(2)(B)(iii)), such security, guarantee, hold-harmless ar-
rangement, or other financial arrangement as the applica-
ble authority determines to be adequate to enable the plan 
to fully meet all its financial obligations on a timely basis 
and is otherwise no less protective of the interests of par-
ticipants and beneficiaries than the requirements for 
which it is substituted. The applicable authority may take 
into account, for purposes of this subsection, evidence pro-
vided by the plan or sponsor which demonstrates an as-
sumption of liability with respect to the plan. Such evi-
dence may be in the form of a contract of indemnification, 
lien, bonding, insurance, letter of credit, recourse under 
applicable terms of the plan in the form of assessments
of participating employers, security, or other financial ar-
rangement. 
‘‘(f) MEASURES TO ENSURE CONTINUED PAYMENT 
OF BENEFITS BY CERTAIN PLANS IN DISTRESS.—
‘‘(1) PAYMENTS BY CERTAIN PLANS TO ASSO-
CIATION HEALTH PLAN FUND.—
‘‘(A) IN GENERAL.—In the case of an as-
sociation health plan described in subsection 
(a)(2), the requirements of this subsection are 
met if the plan makes payments into the Asso-
ciation Health Plan Fund under this subpara-
graph when they are due. Such payments shall 
consist of annual payments in the amount of 
$5,000, and, in addition to such annual pay-
ments, such supplemental payments as the Sec-
retary may determine to be necessary under 
paragraph (2). Payments under this paragraph 
are payable to the Fund at the time determined 
by the Secretary. Initial payments are due in 
advance of certification under this part. Pay-
ments shall continue to accrue until a plan’s as-
sets are distributed pursuant to a termination 
procedure. 
‘‘(B) PENALTIES FOR FAILURE TO MAKE 
PAYMENTS.—If any payment is not made by a
plan when it is due, a late payment charge of 
not more than 100 percent of the payment 
which was not timely paid shall be payable by 
the plan to the Fund. 
‘‘(C) CONTINUED
DUTY
OF
THE
SEC-
RETARY.—The Secretary shall not cease to 
carry out the provisions of paragraph (2) on ac-
count of the failure of a plan to pay any pay-
ment when due. 
‘‘(2) PAYMENTS BY SECRETARY TO CONTINUE 
EXCESS /STOP LOSS INSURANCE COVERAGE AND IN-
DEMNIFICATION
INSURANCE
COVERAGE
FOR
CER-
TAIN PLANS.—In any case in which the applicable 
authority determines that there is, or that there is 
reason to believe that there will be: (A) a failure to 
take necessary corrective actions under section 
809(a) with respect to an association health plan de-
scribed in subsection (a)(2); or (B) a termination of 
such a plan under section 809(b) or 810(b)(8) (and, 
if the applicable authority is not the Secretary, cer-
tifies such determination to the Secretary), the Sec-
retary shall determine the amounts necessary to 
make payments to an insurer (designated by the 
Secretary) to maintain in force excess /stop loss in-
surance coverage or indemnification insurance cov-
erage for such plan, if the Secretary determines that 
there is a reasonable expectation that, without such 
payments, claims would not be satisfied by reason of 
termination of such coverage. The Secretary shall, to 
the extent provided in advance in appropriation 
Acts, pay such amounts so determined to the insurer 
designated by the Secretary. 
‘‘(3) ASSOCIATION HEALTH PLAN FUND.—
‘‘(A) IN GENERAL.—There is established 
on the books of the Treasury a fund to be 
known as the ‘Association Health Plan Fund’. 
The Fund shall be available for making pay-
ments pursuant to paragraph (2). The Fund 
shall be credited with payments received pursu-
ant to paragraph (1)(A), penalties received pur-
suant to paragraph (1)(B); and earnings on in-
vestments of amounts of the Fund under sub-
paragraph (B). 
‘‘(B) INVESTMENT.—Whenever the Sec-
retary determines that the moneys of the fund 
are in excess of current needs, the Secretary 
may request the investment of such amounts as 
the Secretary determines advisable by the Sec-
retary of the Treasury in obligations issued or 
guaranteed by the United States.
‘‘(g) EXCESS /STOP LOSS INSURANCE.—For pur-
poses of this section—
‘‘(1) AGGREGATE
EXCESS /STOP
LOSS
INSUR-
ANCE.—The term ‘aggregate excess /stop loss insur-
ance’ means, in connection with an association 
health plan, a contract—
‘‘(A) under which an insurer (meeting such 
minimum standards as the applicable authority 
may prescribe by regulation through negotiated 
rulemaking) provides for payment to the plan 
with respect to aggregate claims under the plan 
in excess of an amount or amounts specified in 
such contract; 
‘‘(B) which is guaranteed renewable; and 
‘‘(C) which allows for payment of pre-
miums by any third party on behalf of the in-
sured plan. 
‘‘(2) SPECIFIC
EXCESS /STOP
LOSS
INSUR-
ANCE.—The term ‘specific excess /stop loss insur-
ance’ means, in connection with an association 
health plan, a contract—
‘‘(A) under which an insurer (meeting such 
minimum standards as the applicable authority 
may prescribe by regulation through negotiated 
rulemaking) provides for payment to the plan
with respect to claims under the plan in connec-
tion with a covered individual in excess of an 
amount or amounts specified in such contract 
in connection with such covered individual; 
‘‘(B) which is guaranteed renewable; and 
‘‘(C) which allows for payment of pre-
miums by any third party on behalf of the in-
sured plan.
‘‘(h) INDEMNIFICATION INSURANCE.—For purposes 
of this section, the term ‘indemnification insurance’ 
means, in connection with an association health plan, a 
contract—
‘‘(1) under which an insurer (meeting such min-
imum standards as the applicable authority may pre-
scribe through negotiated rulemaking) provides for 
payment to the plan with respect to claims under the 
plan which the plan is unable to satisfy by reason 
of a termination pursuant to section 809(b) (relating 
to mandatory termination); 
‘‘(2) which is guaranteed renewable and 
noncancellable for any reason (except as the applica-
ble authority may prescribe by regulation through 
negotiated rulemaking); and 
‘‘(3) which allows for payment of premiums by 
any third party on behalf of the insured plan.
‘‘(i) RESERVES.—For purposes of this section, the 
term ‘reserves’ means, in connection with an association 
health plan, plan assets which meet the fiduciary stand-
ards under part 4 and such additional requirements re-
garding liquidity as the applicable authority may prescribe 
through negotiated rulemaking. 
‘‘(j) SOLVENCY STANDARDS WORKING GROUP.—
‘‘(1) IN GENERAL.—Within 90 days after the 
date of the enactment of the Small Business Access 
and Choice for Entrepreneurs Act of 2003, the ap-
plicable authority shall establish a Solvency Stand-
ards Working Group. In prescribing the initial regu-
lations under this section, the applicable authority 
shall take into account the recommendations of such 
Working Group. 
‘‘(2) MEMBERSHIP.—The Working Group shall 
consist of not more than 15 members appointed by 
the applicable authority. The applicable authority 
shall include among persons invited to membership 
on the Working Group at least one of each of the 
following: 
‘‘(A) a representative of the National Asso-
ciation of Insurance Commissioners; 
‘‘(B) a representative of the American 
Academy of Actuaries;
be prescribed by the applicable authority through nego-
tiated rulemaking, at least the following information: 
‘‘(1) IDENTIFYING INFORMATION.—The names 
and addresses of—
‘‘(A) the sponsor; and 
‘‘(B) the members of the board of trustees 
of the plan. 
‘‘(2) STATES IN WHICH PLAN INTENDS TO DO 
BUSINESS.—The States in which participants and 
beneficiaries under the plan are to be located and 
the number of them expected to be located in each 
such State. 
‘‘(3) BONDING REQUIREMENTS.—Evidence pro-
vided by the board of trustees that the bonding re-
quirements of section 412 will be met as of the date 
of the application or (if later) commencement of op-
erations. 
‘‘(4) PLAN DOCUMENTS.—A copy of the docu-
ments governing the plan (including any bylaws and 
trust agreements), the summary plan description, 
and other material describing the benefits that will 
be provided to participants and beneficiaries under 
the plan. 
‘‘(5) 
AGREEMENTS
WITH
SERVICE
PRO-
VIDERS.—A copy of any agreements between the
plan and contract administrators and other service 
providers. 
‘‘(6) FUNDING REPORT.—In the case of asso-
ciation health plans providing benefits options in ad-
dition to health insurance coverage, a report setting 
forth information with respect to such additional 
benefit options determined as of a date within the 
120-day period ending with the date of the applica-
tion, including the following: 
‘‘(A) RESERVES.—A statement, certified 
by the board of trustees of the plan, and a 
statement of actuarial opinion, signed by a 
qualified actuary, that all applicable require-
ments of section 806 are or will be met in ac-
cordance with regulations which the applicable 
authority shall prescribe through negotiated 
rulemaking. 
‘‘(B) 
ADEQUACY
OF
CONTRIBUTION 
RATES.—A statement of actuarial opinion, 
signed by a qualified actuary, which sets forth 
a description of the extent to which contribution 
rates are adequate to provide for the payment 
of all obligations and the maintenance of re-
quired reserves under the plan for the 12-
month period beginning with such date within
such 120-day period, taking into account the 
expected coverage and experience of the plan. If 
the contribution rates are not fully adequate, 
the statement of actuarial opinion shall indicate 
the extent to which the rates are inadequate 
and the changes needed to ensure adequacy.
‘‘(C) CURRENT AND PROJECTED VALUE OF 
ASSETS AND LIABILITIES.—A statement of ac-
tuarial opinion signed by a qualified actuary, 
which sets forth the current value of the assets 
and liabilities accumulated under the plan and 
a projection of the assets, liabilities, income, 
and expenses of the plan for the 12-month pe-
riod referred to in subparagraph (B). The in-
come statement shall identify separately the 
plan’s administrative expenses and claims. 
‘‘(D) 
COSTS
OF
COVERAGE
TO
BE 
CHARGED
AND
OTHER
EXPENSES.—A state-
ment of the costs of coverage to be charged, in-
cluding an itemization of amounts for adminis-
tration, reserves, and other expenses associated 
with the operation of the plan. 
‘‘(E) OTHER
INFORMATION.—Any other 
information as may be determined by the appli-
cable authority, by regulation through nego-
tiated rulemaking, as necessary to carry out the 
purposes of this part. 
‘‘(c) FILING
NOTICE
OF
CERTIFICATION
WITH 
STATES.—A certification granted under this part to an 
association health plan shall not be effective unless written 
notice of such certification is filed with the applicable 
State authority of each State in which at least 25 percent 
of the participants and beneficiaries under the plan are 
located. For purposes of this subsection, an individual 
shall be considered to be located in the State in which a 
known address of such individual is located or in which 
such individual is employed. 
‘‘(d) NOTICE OF MATERIAL CHANGES.—In the case 
of any association health plan certified under this part, 
descriptions of material changes in any information which 
was required to be submitted with the application for the 
certification under this part shall be filed in such form 
and manner as shall be prescribed by the applicable au-
thority by regulation through negotiated rulemaking. The 
applicable authority may require by regulation, through 
negotiated rulemaking, prior notice of material changes 
with respect to specified matters which might serve as the 
basis for suspension or revocation of the certification. 
‘‘(e) REPORTING REQUIREMENTS FOR CERTAIN AS-
SOCIATION HEALTH PLANS.—An association health plan
certified under this part which provides benefit options in 
addition to health insurance coverage for such plan year 
shall meet the requirements of section 103 by filing an 
annual report under such section which shall include infor-
mation described in subsection (b)(6) with respect to the 
plan year and, notwithstanding section 104(a)(1)(A), shall 
be filed with the applicable authority not later than 90 
days after the close of the plan year (or on such later date 
as may be prescribed by the applicable authority). The ap-
plicable authority may require by regulation through nego-
tiated rulemaking such interim reports as it considers ap-
propriate. 
‘‘(f) ENGAGEMENT OF QUALIFIED ACTUARY.—The 
board of trustees of each association health plan which 
provides benefits options in addition to health insurance 
coverage and which is applying for certification under this 
part or is certified under this part shall engage, on behalf 
of all participants and beneficiaries, a qualified actuary 
who shall be responsible for the preparation of the mate-
rials comprising information necessary to be submitted by 
a qualified actuary under this part. The qualified actuary 
shall utilize such assumptions and techniques as are nec-
essary to enable such actuary to form an opinion as to 
whether the contents of the matters reported under this 
part—
‘‘(1) are in the aggregate reasonably related to 
the experience of the plan and to reasonable expecta-
tions; and 
‘‘(2) represent such actuary’s best estimate of 
anticipated experience under the plan. 
The opinion by the qualified actuary shall be made with 
respect to, and shall be made a part of, the annual report. 
‘‘SEC. 808. NOTICE REQUIREMENTS FOR VOLUNTARY TER-
MINATION. 
‘‘Except as provided in section 809(b), an association 
health plan which is or has been certified under this part 
may terminate (upon or at any time after cessation of ac-
cruals in benefit liabilities) only if the board of trustees—
‘‘(1) not less than 60 days before the proposed 
termination date, provides to the participants and 
beneficiaries a written notice of intent to terminate 
stating that such termination is intended and the 
proposed termination date; 
‘‘(2) develops a plan for winding up the affairs 
of the plan in connection with such termination in 
a manner which will result in timely payment of all 
benefits for which the plan is obligated; and 
‘‘(3) submits such plan in writing to the appli-
cable authority.
Actions required under this section shall be taken in such 
form and manner as may be prescribed by the applicable 
authority by regulation through negotiated rulemaking.
‘‘SEC. 809. CORRECTIVE ACTIONS AND MANDATORY TERMI-
NATION. 
‘‘(a) ACTIONS
TO
AVOID
DEPLETION
OF
RE-
SERVES.—An association health plan which is certified 
under this part and which provides benefits other than 
health insurance coverage shall continue to meet the re-
quirements of section 806, irrespective of whether such 
certification continues in effect. The board of trustees of 
such plan shall determine quarterly whether the require-
ments of section 806 are met. In any case in which the 
board determines that there is reason to believe that there 
is or will be a failure to meet such requirements, or the 
applicable authority makes such a determination and so 
notifies the board, the board shall immediately notify the 
qualified actuary engaged by the plan, and such actuary 
shall, not later than the end of the next following month, 
make such recommendations to the board for corrective 
action as the actuary determines necessary to ensure com-
pliance with section 806. Not later than 30 days after re-
ceiving from the actuary recommendations for corrective 
actions, the board shall notify the applicable authority (in 
such form and manner as the applicable authority may
course of the termination, take such actions as the appli-
cable authority may require, including satisfying any 
claims referred to in section 806(a)(2)(B)(iii) and recov-
ering for the plan any liability under subsection 
(a)(2)(B)(iii) or (e) of section 806, as necessary to ensure 
that the affairs of the plan will be, to the maximum extent 
possible, wound up in a manner which will result in timely 
provision of all benefits for which the plan is obligated. 
‘‘SEC. 810. TRUSTEESHIP BY THE SECRETARY OF INSOL-
VENT ASSOCIATION HEALTH PLANS PRO-
VIDING HEALTH BENEFITS IN ADDITION TO 
HEALTH INSURANCE COVERAGE. 
‘‘(a) APPOINTMENT OF SECRETARY AS TRUSTEE FOR 
INSOLVENT PLANS.—Whenever the Secretary determines 
that an association health plan which is or has been cer-
tified under this part and which is described in section 
806(a)(2) will be unable to provide benefits when due or 
is otherwise in a financially hazardous condition, as shall 
be defined by the Secretary by regulation through nego-
tiated rulemaking, the Secretary shall, upon notice to the 
plan, apply to the appropriate United States district court 
for appointment of the Secretary as trustee to administer 
the plan for the duration of the insolvency. The plan may 
appear as a party and other interested persons may inter-
vene in the proceedings at the discretion of the court. The
court shall appoint such Secretary trustee if the court de-
termines that the trusteeship is necessary to protect the 
interests of the participants and beneficiaries or providers 
of medical care or to avoid any unreasonable deterioration 
of the financial condition of the plan. The trusteeship of 
such Secretary shall continue until the conditions de-
scribed in the first sentence of this subsection are rem-
edied or the plan is terminated. 
‘‘(b) POWERS AS TRUSTEE.—The Secretary, upon 
appointment as trustee under subsection (a), shall have 
the power—
‘‘(1) to do any act authorized by the plan, this 
title, or other applicable provisions of law to be done 
by the plan administrator or any trustee of the plan; 
‘‘(2) to require the transfer of all (or any part) 
of the assets and records of the plan to the Sec-
retary as trustee; 
‘‘(3) to invest any assets of the plan which the 
Secretary holds in accordance with the provisions of 
the plan, regulations prescribed by the Secretary 
through negotiated rulemaking, and applicable provi-
sions of law; 
‘‘(4) to require the sponsor, the plan adminis-
trator, any participating employer, and any employee 
organization representing plan participants to fur-
nish any information with respect to the plan which 
the Secretary as trustee may reasonably need in 
order to administer the plan; 
‘‘(5) to collect for the plan any amounts due the 
plan and to recover reasonable expenses of the trust-
eeship; 
‘‘(6) to commence, prosecute, or defend on be-
half of the plan any suit or proceeding involving the 
plan; 
‘‘(7) to issue, publish, or file such notices, state-
ments, and reports as may be required by the Sec-
retary by regulation through negotiated rulemaking 
or required by any order of the court; 
‘‘(8) to terminate the plan (or provide for its 
termination accordance with section 809(b)) and liq-
uidate the plan assets, to restore the plan to the re-
sponsibility of the sponsor, or to continue the trust-
eeship; 
‘‘(9) to provide for the enrollment of plan par-
ticipants and beneficiaries under appropriate cov-
erage options; and 
‘‘(10) to do such other acts as may be nec-
essary to comply with this title or any order of the 
court and to protect the interests of plan partici-
pants and beneficiaries and providers of medical 
care.
‘‘(c) NOTICE OF APPOINTMENT.—As soon as prac-
ticable after the Secretary’s appointment as trustee, the 
Secretary shall give notice of such appointment to—
‘‘(1) the sponsor and plan administrator; 
‘‘(2) each participant; 
‘‘(3) each participating employer; and 
‘‘(4) if applicable, each employee organization 
which, for purposes of collective bargaining, rep-
resents plan participants. 
‘‘(d) ADDITIONAL DUTIES.—Except to the extent in-
consistent with the provisions of this title, or as may be 
otherwise ordered by the court, the Secretary, upon ap-
pointment as trustee under this section, shall be subject 
to the same duties as those of a trustee under section 704 
of title 11, United States Code, and shall have the duties 
of a fiduciary for purposes of this title. 
‘‘(e) OTHER PROCEEDINGS.—An application by the 
Secretary under this subsection may be filed notwith-
standing the pendency in the same or any other court of 
any bankruptcy, mortgage foreclosure, or equity receiver-
ship proceeding, or any proceeding to reorganize, conserve, 
or liquidate such plan or its property, or any proceeding 
to enforce a lien against property of the plan.
‘‘(f) JURISDICTION OF COURT.—
‘‘(1) IN GENERAL.—Upon the filing of an appli-
cation for the appointment as trustee or the issuance 
of a decree under this section, the court to which the 
application is made shall have exclusive jurisdiction 
of the plan involved and its property wherever lo-
cated with the powers, to the extent consistent with 
the purposes of this section, of a court of the United 
States having jurisdiction over cases under chapter 
11 of title 11, United States Code. Pending an adju-
dication under this section such court shall stay, and 
upon appointment by it of the Secretary as trustee, 
such court shall continue the stay of, any pending 
mortgage foreclosure, equity receivership, or other 
proceeding to reorganize, conserve, or liquidate the 
plan, the sponsor, or property of such plan or spon-
sor, and any other suit against any receiver, conser-
vator, or trustee of the plan, the sponsor, or prop-
erty of the plan or sponsor. Pending such adjudica-
tion and upon the appointment by it of the Sec-
retary as trustee, the court may stay any proceeding 
to enforce a lien against property of the plan or the 
sponsor or any other suit against the plan or the 
sponsor.
‘‘(2) VENUE.—An action under this section 
may be brought in the judicial district where the 
sponsor or the plan administrator resides or does 
business or where any asset of the plan is situated. 
A district court in which such action is brought may 
issue process with respect to such action in any 
other judicial district. 
‘‘(g) PERSONNEL.—In accordance with regulations 
which shall be prescribed by the Secretary through nego-
tiated rulemaking, the Secretary shall appoint, retain, and 
compensate accountants, actuaries, and other professional 
service personnel as may be necessary in connection with 
the Secretary’s service as trustee under this section. 
‘‘SEC. 811. STATE ASSESSMENT AUTHORITY. 
‘‘(a) IN GENERAL.—Notwithstanding section 514, a 
State may impose by law a contribution tax on an associa-
tion health plan described in section 806(a)(2), if the plan 
commenced operations in such State after the date of the 
enactment of the Small Business Access and Choice for 
Entrepreneurs Act of 2003. 
‘‘(b) CONTRIBUTION TAX.—For purposes of this sec-
tion, the term ‘contribution tax’ imposed by a State on 
an association health plan means any tax imposed by such 
State if—
‘‘(1) such tax is computed by applying a rate to 
the amount of premiums or contributions, with re-
spect to individuals covered under the plan who are 
residents of such State, which are received by the 
plan from participating employers located in such 
State or from such individuals; 
‘‘(2) the rate of such tax does not exceed the 
rate of any tax imposed by such State on premiums 
or contributions received by insurers or health main-
tenance organizations for health insurance coverage 
offered in such State in connection with a group 
health plan; 
‘‘(3) such tax is otherwise nondiscriminatory; 
and 
‘‘(4) the amount of any such tax assessed on 
the plan is reduced by the amount of any tax or as-
sessment otherwise imposed by the State on pre-
miums, contributions, or both received by insurers or 
health maintenance organizations for health insur-
ance coverage, aggregate excess /stop loss insurance 
(as defined in section 806(g)(1)), specific excess /
stop loss insurance (as defined in section 806(g)(2)), 
other insurance related to the provision of medical 
care under the plan, or any combination thereof pro-
vided by such insurers or health maintenance organi-
zations in such State in connection with such plan. 
‘‘SEC. 812. SPECIAL RULES FOR CHURCH PLANS. 
‘‘(a) ELECTION
FOR CHURCH PLANS.—Notwith-
standing section 4(b)(2), if a church, a convention or asso-
ciation of churches, or an organization described in section 
3(33)(C)(i) maintains a church plan which is a group 
health plan (as defined in section 733(a)(1)), and such 
church, convention, association, or organization makes an 
election with respect to such plan under this subsection 
(in such form and manner as the Secretary may by regula-
tion prescribe), then the provisions of this section shall 
apply to such plan, with respect to benefits provided under 
such plan consisting of medical care, as if section 4(b)(2) 
did not contain an exclusion for church plans. Nothing in 
this subsection shall be construed to render any other sec-
tion of this title applicable to church plans, except to the 
extent that such other section is incorporated by reference 
in this section. 
‘‘(b) EFFECT OF ELECTION.—
‘‘(1) PREEMPTION OF STATE INSURANCE LAWS 
REGULATING COVERED CHURCH PLANS.—Subject to 
paragraphs (2) and (3), this section shall supersede 
any and all State laws which regulate insurance in-
sofar as they may now or hereafter regulate church
plans to which this section applies or trusts estab-
lished under such church plans.
‘‘(2) GENERAL STATE INSURANCE REGULATION 
UNAFFECTED.—
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B) and paragraph (3), nothing 
in this section shall be construed to exempt or 
relieve any person from any provision of State 
law which regulates insurance. 
‘‘(B) CHURCH PLANS NOT TO BE DEEMED 
INSURANCE COMPANIES OR INSURERS.—Neither 
a church plan to which this section applies, nor 
any trust established under such a church plan, 
shall be deemed to be an insurance company or 
other insurer or to be engaged in the business 
of insurance for purposes of any State law pur-
porting to regulate insurance companies or in-
surance contracts. 
‘‘(3) PREEMPTION
OF
CERTAIN
STATE
LAWS 
RELATING
TO
PREMIUM
RATE
REGULATION
AND 
BENEFIT MANDATES.—The provisions of subsections 
(a)(2)(B) and (b) of section 805 shall apply with re-
spect to a church plan to which this section applies 
in the same manner and to the same extent as such
provisions apply with respect to association health 
plans. 
‘‘(4) DEFINITIONS.—For purposes of this sub-
section—
‘‘(A) STATE LAW.—The term ‘State law’ 
includes all laws, decisions, rules, regulations, 
or other State action having the effect of law, 
of any State. A law of the United States appli-
cable only to the District of Columbia shall be 
treated as a State law rather than a law of the 
United States. 
‘‘(B) STATE.—The term ‘State’ includes a 
State, any political subdivision thereof, or any 
agency or instrumentality of either, which pur-
ports to regulate, directly or indirectly, the 
terms and conditions of church plans covered by 
this section. 
‘‘(c) 
REQUIREMENTS
FOR
COVERED
CHURCH 
PLANS.—
‘‘(1) FIDUCIARY RULES AND EXCLUSIVE PUR-
POSE.—A fiduciary shall discharge his duties with 
respect to a church plan to which this section ap-
plies—
‘‘(A) for the exclusive purpose of:
‘‘(i) providing benefits to participants 
and their beneficiaries; and 
‘‘(ii) defraying reasonable expenses of 
administering the plan; 
‘‘(B) with the care, skill, prudence and dili-
gence under the circumstances then prevailing 
that a prudent man acting in a like capacity 
and familiar with such matters would use in the 
conduct of an enterprise of a like character and 
with like aims; and 
‘‘(C) in accordance with the documents 
and instruments governing the plan. 
The requirements of this paragraph shall not be 
treated as not satisfied solely because the plan as-
sets are commingled with other church assets, to the 
extent that such plan assets are separately ac-
counted for. 
‘‘(2) CLAIMS PROCEDURE.—In accordance with 
regulations of the Secretary, every church plan to 
which this section applies shall—
‘‘(A) provide adequate notice in writing to 
any participant or beneficiary whose claim for 
benefits under the plan has been denied, setting 
forth the specific reasons for such denial, writ-
ten in a manner calculated to be understood by 
the participant; 
‘‘(B) afford a reasonable opportunity to 
any participant whose claim for benefits has 
been denied for a full and fair review by the ap-
propriate fiduciary of the decision denying the 
claim; and 
‘‘(C) provide a written statement to each 
participant describing the procedures estab-
lished pursuant to this paragraph. 
‘‘(3) ANNUAL
STATEMENTS.—In accordance 
with regulations of the Secretary, every church plan 
to which this section applies shall file with the Sec-
retary an annual statement—
‘‘(A) stating the names and addresses of 
the plan and of the church, convention, or asso-
ciation maintaining the plan (and its principal 
place of business); 
‘‘(B) certifying that it is a church plan to 
which this section applies and that it complies 
with the requirements of paragraphs (1) and 
(2); 
‘‘(C) identifying the States in which par-
ticipants and beneficiaries under the plan are or
likely will be located during the 1-year period 
covered by the statement; and 
‘‘(D) containing a copy of a statement of 
actuarial opinion signed by a qualified actuary 
that the plan maintains capital, reserves, insur-
ance, other financial arrangements, or any com-
bination thereof adequate to enable the plan to 
fully meet all of its financial obligations on a 
timely basis. 
‘‘(4) DISCLOSURE.—At the time that the an-
nual statement is filed by a church plan with the 
Secretary pursuant to paragraph (3), a copy of such 
statement shall be made available by the Secretary 
to the State insurance commissioner (or similar offi-
cial) of any State. The name of each church plan 
and sponsoring organization filing an annual state-
ment in compliance with paragraph (3) shall be pub-
lished annually in the Federal Register. 
‘‘(d) ENFORCEMENT.—The Secretary may enforce 
the provisions of this section in a manner consistent with 
section 502, to the extent applicable with respect to ac-
tions under section 502(a)(5), and with section 3(33)(D), 
except that, other than for the purpose of seeking a tem-
porary restraining order, a civil action may be brought 
with respect to the plan’s failure to meet any requirement
of this section only if the plan fails to correct its failure 
within the correction period described in section 3(33)(D). 
The other provisions of part 5 (except sections 501(a), 
503, 512, 514, and 515) shall apply with respect to the 
enforcement and administration of this section. 
‘‘(e) DEFINITIONS AND OTHER RULES.—For pur-
poses of this section—
‘‘(1) IN GENERAL.—Except as otherwise pro-
vided in this section, any term used in this section 
which is defined in any provision of this title shall 
have the definition provided such term by such pro-
vision. 
‘‘(2) SEMINARY STUDENTS.—Seminary students 
who are enrolled in an institution of higher learning 
described in section 3(33)(C)(iv) and who are treat-
ed as participants under the terms of a church plan 
to which this section applies shall be deemed to be 
employees as defined in section 3(6) if the number 
of such students constitutes an insignificant portion 
of the total number of individuals who are treated 
as participants under the terms of the plan. 
‘‘SEC. 813. DEFINITIONS AND RULES OF CONSTRUCTION. 
‘‘(a) DEFINITIONS.—For purposes of this part—
‘‘(1) GROUP HEALTH PLAN.—The term ‘group 
health plan’ has the meaning provided in section
733(a)(1) (after applying subsection (b) of this sec-
tion). 
‘‘(2) MEDICAL CARE.—The term ‘medical care’ 
has the meaning provided in section 733(a)(2). 
‘‘(3) HEALTH
INSURANCE
COVERAGE.—The 
term ‘health insurance coverage’ has the meaning 
provided in section 733(b)(1). 
‘‘(4) HEALTH INSURANCE ISSUER.—The term 
‘health insurance issuer’ has the meaning provided 
in section 733(b)(2). 
‘‘(5) APPLICABLE AUTHORITY.—
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (B), the term ‘applicable author-
ity’ means, in connection with an association 
health plan—
‘‘(i) the State recognized pursuant to 
subsection (c) of section 506 as the State 
to which authority has been delegated in 
connection with such plan; or 
‘‘(ii) if there is no State referred to in 
clause (i), the Secretary. 
‘‘(B) EXCEPTIONS.—
‘‘(i) 
JOINT
AUTHORITIES.—Where 
such term appears in section 808(3), sec-
tion 807(e) (in the first instance), section
809(a) (in the second instance), section 
809(a) (in the fourth instance), and sec-
tion 809(b)(1), such term means, in con-
nection with an association health plan, the 
Secretary and the State referred to in sub-
paragraph (A)(i) (if any) in connection 
with such plan. 
‘‘(ii) REGULATORY
AUTHORITIES.—
Where such term appears in section 802(a) 
(in the first instance), section 802(d), sec-
tion 
802(e), 
section 
803(d), 
section 
805(a)(5), 
section 
806(a)(2), 
section 
806(b), section 806(c), section 806(d), 
paragraphs (1)(A) and (2)(A) of section 
806(g), section 806(h), section 806(i), sec-
tion 806(j), section 807(a) (in the second 
instance), section 807(b), section 807(d), 
section 807(e) (in the second instance), 
section 808 (in the matter after paragraph 
(3)), and section 809(a) (in the third in-
stance), such term means, in connection 
with an association health plan, the Sec-
retary.