IB 
Union Calendar No. 87 
118TH CONGRESS 
1ST SESSION H. R. 2868 
[Report No. 118–112] 
To amend the Employee Retirement Income Security Act of 1974 to clarify 
the treatment of certain association health plans as employers, and 
for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 25, 2023 
Mr. WALBERG (for himself, Ms. FOXX, Mr. GOOD of Virginia, Mr. ALLEN, 
Mr. CRENSHAW, and Mr. BURGESS) introduced the following bill; which 
was referred to the Committee on Education and the Workforce 
JUNE 14, 2023 
Additional sponsors: Mr. THOMPSON of Pennsylvania and Mr. DUNN of 
Florida 
JUNE 14, 2023 
Reported with an amendment, committed to the Committee of the Whole 
House on the State of the Union, and ordered to be printed 
[Strike out all after the enacting clause and insert the part printed in italic] 
[For text of introduced bill, see copy of bill as introduced on April 25, 2023] 
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A BILL 
To amend the Employee Retirement Income Security Act 
of 1974 to clarify the treatment of certain association 
health plans as employers, and for other purposes. 
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Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Association Health 
Plans Act’’. 
SEC. 2. TREATMENT OF GROUP OR ASSOCIATION OF EM-
PLOYERS. 
(a) IN GENERAL.—Section 3(5) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 1002(5)) 
is amended— 
(1) by striking ‘‘The term’’ and inserting ‘‘(A) 
The term’’; and 
(2) by adding at the end the following: 
‘‘(B) For purposes of subparagraph (A), a group or 
association of employers shall be treated as an ‘employer’, 
regardless of whether the employers composing such group 
or association are in the same industry, trade, or profes-
sion, if such group or association— 
‘‘(i)(I) has established and maintains an em-
ployee welfare benefit plan that is a group health 
plan (as defined in section 733(a)(1)); 
‘‘(II) provides coverage under such plan to at 
least 51 employees after all of the employees employed 
by all of the employer members of such group or asso-
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ciation have been aggregated and counted together as 
described in subparagraph (D); 
‘‘(III) has been actively in existence for at least 
2 years prior to establishing and maintaining an em-
ployer welfare benefit plan that is a group health 
plan (as defined in section 733(a)(1)); 
‘‘(IV) has been formed and maintained in good 
faith for purposes other than providing medical care 
(as defined in section 733(a)(2)) through the purchase 
of insurance or otherwise; 
‘‘(V) does not condition membership in the group 
or association on any health status-related factor (as 
described in section 702(a)(1)) relating to any indi-
vidual; 
‘‘(VI) makes coverage under such plan available 
to all employer members of such group or association 
regardless of any health status-related factor (as de-
scribed in section 702(a)(1)) relating to such em-
ployer members; 
‘‘(VII) does not provide coverage under such plan 
to any individual other than an employee of an em-
ployer member of such group or association; 
‘‘(VIII) has established a governing board with 
by-laws or other similar indications of formality to 
manage and operate such plan in both form and sub-
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stance, of which at least 75 percent of the board mem-
bers shall be made up of employer members of such 
group or association participating in the plan that 
are duly elected by each participating employer mem-
ber casting 1 vote during a scheduled election; 
‘‘(IX) is not a health insurance issuer (as defined 
in section 733(b)(2)), and is not owned or controlled 
by such a health insurance issuer or by a subsidiary 
or affiliate of such a health insurance issuer, other 
than to the extent such a health insurance issuer— 
‘‘(aa) may participate in the group or asso-
ciation as a member; and 
‘‘(bb) may provide services such as assist-
ance with plan development, marketing, and ad-
ministrative services to such group or associa-
tion; 
‘‘(ii) meets any set of criteria to qualify for such 
treatment in an advisory opinion issued by the Sec-
retary prior to the date of enactment of the Associa-
tion Health Plans Act; or 
‘‘(iii) meets any other set of criteria to qualify 
for such treatment that the Secretary by regulation 
may provide. 
‘‘(C)(i) For purposes of subparagraph (B), a self-em-
ployed individual shall be treated as— 
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‘‘(I) an employer who may become a member of 
a group or association of employers; 
‘‘(II) an employee who may participate in an 
employee welfare benefit plan established and main-
tained by such group or association; and 
‘‘(III) a participant of such plan subject to the 
eligibility determination and monitoring require-
ments set forth in clause (iii). 
‘‘(ii) For purposes of this subparagraph, the term ‘self- 
employed individual’ means an individual who— 
‘‘(I) does not have any common law employees; 
‘‘(II) has an ownership right in a trade or busi-
ness, regardless of whether such trade or business is 
incorporated or unincorporated; 
‘‘(III) earns wages (as defined in section 3121(a) 
of the Internal Revenue Code of 1986) or self-employ-
ment income (as defined in section 1402(b) of such 
Code) from such trade or business; and 
‘‘(IV) works at least 10 hours per week or 40 
hours per month providing personal services to such 
trade or business. 
‘‘(iii) The board of a group or association of employers 
shall— 
‘‘(I) initially determine whether an individual 
meets the requirements under clause (ii) to be consid-
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