447 
‘‘(3) TREATMENT
OF
PREPAID
HEALTH
COV-
ERAGE ARRANGEMENTS.— 
‘‘(A) IN GENERAL.—In the case of any ar-
rangement described in subparagraph (B)— 
‘‘(i) such arrangement shall be treated 
as a specified health insurance policy, and 
‘‘(ii) the person referred to in such sub-
paragraph shall be treated as the issuer. 
‘‘(B) DESCRIPTION
OF
ARRANGEMENTS.— 
An arrangement is described in this subpara-
graph if under such arrangement fixed payments 
or premiums are received as consideration for 
any person’s agreement to provide or arrange for 
the provision of accident or health coverage to 
residents of the United States, regardless of how 
such coverage is provided or arranged to be pro-
vided. 
‘‘SEC. 4376. SELF-INSURED HEALTH PLANS. 
‘‘(a) IMPOSITION OF FEE.—In the case of any applica-
ble self-insured health plan for each plan year, there is here-
by imposed a fee equal to the fair share per capita amount 
determined under section 9511(c)(1) multiplied by the aver-
age number of lives covered under the plan. 
‘‘(b) LIABILITY FOR FEE.— 
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448 
‘‘(1) IN
GENERAL.—The fee imposed by sub-
section (a) shall be paid by the plan sponsor. 
‘‘(2) PLAN
SPONSOR.—For purposes of para-
graph (1) the term ‘plan sponsor’ means— 
‘‘(A) the employer in the case of a plan es-
tablished or maintained by a single employer, 
‘‘(B) the employee organization in the case 
of a plan established or maintained by an em-
ployee organization, 
‘‘(C) in the case of— 
‘‘(i) a plan established or maintained 
by 2 or more employers or jointly by 1 or 
more employers and 1 or more employee or-
ganizations, 
‘‘(ii) a multiple employer welfare ar-
rangement, or 
‘‘(iii) a voluntary employees’ bene-
ficiary association described in section 
501(c)(9), 
the association, committee, joint board of trust-
ees, or other similar group of representatives of 
the parties who establish or maintain the plan, 
or 
‘‘(D) the cooperative or association de-
scribed in subsection (c)(2)(F) in the case of a 
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plan established or maintained by such a cooper-
ative or association. 
‘‘(c) APPLICABLE SELF-INSURED HEALTH PLAN.— 
For purposes of this section, the term ‘applicable self-in-
sured health plan’ means any plan for providing accident 
or health coverage if— 
‘‘(1) any portion of such coverage is provided 
other than through an insurance policy, and 
‘‘(2) such plan is established or maintained— 
‘‘(A) by one or more employers for the ben-
efit of their employees or former employees, 
‘‘(B) by one or more employee organizations 
for the benefit of their members or former mem-
bers, 
‘‘(C) jointly by 1 or more employers and 1 
or more employee organizations for the benefit of 
employees or former employees, 
‘‘(D) by a voluntary employees’ beneficiary 
association described in section 501(c)(9), 
‘‘(E) by any organization described in sec-
tion 501(c)(6), or 
‘‘(F) in the case of a plan not described in 
the preceding subparagraphs, by a multiple em-
ployer welfare arrangement (as defined in sec-
tion 3(40) of Employee Retirement Income Secu-
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450 
rity Act of 1974), a rural electric cooperative (as 
defined in section 3(40)(B)(iv) of such Act), or 
a rural telephone cooperative association (as de-
fined in section 3(40)(B)(v) of such Act). 
‘‘SEC. 4377. DEFINITIONS AND SPECIAL RULES. 
‘‘(a) DEFINITIONS.—For purposes of this subchapter— 
‘‘(1) ACCIDENT AND HEALTH COVERAGE.—The 
term ‘accident and health coverage’ means any cov-
erage which, if provided by an insurance policy, 
would cause such policy to be a specified health insur-
ance policy (as defined in section 4375(c)). 
‘‘(2) INSURANCE POLICY.—The term ‘insurance 
policy’ means any policy or other instrument whereby 
a contract of insurance is issued, renewed, or ex-
tended. 
‘‘(3) UNITED STATES.—The term ‘United States’ 
includes any possession of the United States. 
‘‘(b) TREATMENT OF GOVERNMENTAL ENTITIES.— 
‘‘(1) IN GENERAL.—For purposes of this sub-
chapter— 
‘‘(A) the term ‘person’ includes any govern-
mental entity, and 
‘‘(B) notwithstanding any other law or rule 
of law, governmental entities shall not be exempt 
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from the fees imposed by this subchapter except 
as provided in paragraph (2). 
‘‘(2) TREATMENT
OF
EXEMPT
GOVERNMENTAL 
PROGRAMS.—In the case of an exempt governmental 
program, no fee shall be imposed under section 4375 
or section 4376 on any covered life under such pro-
gram. 
‘‘(3) EXEMPT
GOVERNMENTAL
PROGRAM
DE-
FINED.—For purposes of this subchapter, the term ‘ex-
empt governmental program’ means— 
‘‘(A) any insurance program established 
under title XVIII of the Social Security Act, 
‘‘(B) the medical assistance program estab-
lished by title XIX or XXI of the Social Security 
Act, 
‘‘(C) any program established by Federal 
law for providing medical care (other than 
through insurance policies) to individuals (or the 
spouses and dependents thereof) by reason of 
such individuals being— 
‘‘(i) members of the Armed Forces of 
the United States, or 
‘‘(ii) veterans, and 
‘‘(D) any program established by Federal 
law for providing medical care (other than 
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452 
through insurance policies) to members of Indian 
tribes (as defined in section 4(d) of the Indian 
Health Care Improvement Act). 
‘‘(c) TREATMENT AS TAX.—For purposes of subtitle F, 
the fees imposed by this subchapter shall be treated as if 
they were taxes. 
‘‘(d) NO COVER OVER TO POSSESSIONS.—Notwith-
standing any other provision of law, no amount collected 
under this subchapter shall be covered over to any posses-
sion of the United States.’’ 
(B) CLERICAL AMENDMENTS.— 
(i) Chapter 34 of such Code is amend-
ed by striking the chapter heading and in-
serting the following: 
‘‘CHAPTER 34—TAXES ON CERTAIN 
INSURANCE POLICIES 
‘‘SUBCHAPTER A. POLICIES ISSUED BY FOREIGN INSURERS 
‘‘SUBCHAPTER B. INSURED AND SELF-INSURED HEALTH PLANS 
‘‘Subchapter A—Policies Issued By Foreign 
Insurers’’. 
(ii) The table of chapters for subtitle D 
of such Code is amended by striking the 
item relating to chapter 34 and inserting 
the following new item: 
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