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‘‘(C) any combination of the Secretary’s 
authority authorized to be delegated under sub-
paragraphs (A) and (B). 
‘‘(2) DELEGATIONS.—Any department, agency, 
or instrumentality of a State to which authority is 
delegated pursuant to an agreement entered into 
under this paragraph may, if authorized under State 
law and to the extent consistent with such agree-
ment, exercise the powers of the Secretary under 
this title which relate to such authority. 
‘‘(3) RECOGNITION
OF
PRIMARY
DOMICILE 
STATE.—In entering into any agreement with a 
State under subparagraph (A), the Secretary shall 
ensure that, as a result of such agreement and all 
other agreements entered into under subparagraph 
(A), only one State will be recognized, with respect 
to any particular association health plan, as the 
State to which all authority has been delegated pur-
suant to such agreements in connection with such 
plan. In carrying out this paragraph, the Secretary 
shall take into account the places of residence of the 
participants and beneficiaries under the plan and the 
State in which the trust is maintained.’’.
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SEC. 407. EFFECTIVE DATE AND TRANSITIONAL AND 
OTHER RULES. 
(a) EFFECTIVE DATE.—The amendments made by 
sections 101, 104, and 105 shall take effect on January 
1, 2007. The amendments made by sections 102 and 103 
shall take effect on the date of the enactment of this Act. 
The Secretary of Labor shall first issue all regulations 
necessary to carry out the amendments made by this sub-
title before January 1, 2007. Such regulations shall be 
issued through negotiated rulemaking. 
(b) EXCEPTION.—Section 801(a)(2) of the Employee 
Retirement Income Security Act of 1974 (added by section 
101) does not apply in connection with an association 
health plan (certified under part 8 of subtitle B of title 
I of such Act) existing on the date of the enactment of 
this Act, if no benefits provided thereunder as of the date 
of the enactment of this Act consist of health insurance 
coverage (as defined in section 733(b)(1) of such Act). 
(c) TREATMENT
OF CERTAIN EXISTING HEALTH 
BENEFITS PROGRAMS.— 
(1) IN GENERAL.—In any case in which, as of 
the date of the enactment of this Act, an arrange-
ment is maintained in a State for the purpose of 
providing benefits consisting of medical care for the 
employees and beneficiaries of its participating em-
ployers, at least 200 participating employers make
121 
contributions to such arrangement, such arrange-
ment has been in existence for at least 10 years, and 
such arrangement is licensed under the laws of one 
or more States to provide such benefits to its par-
ticipating employers, upon the filing with the appli-
cable authority (as defined in section 813(a)(5) of 
the Employee Retirement Income Security Act of 
1974 (as amended by this Act)) by the arrangement 
of an application for certification of the arrangement 
under part 8 of subtitle B of title I of such Act— 
(A) such arrangement shall be deemed to 
be a group health plan for purposes of title I 
of such Act; 
(B) the requirements of sections 801(a)(1) 
and 803(a)(1) of the Employee Retirement In-
come Security Act of 1974 shall be deemed met 
with respect to such arrangement; 
(C) the requirements of section 803(b) of 
such Act shall be deemed met, if the arrange-
ment is operated by a board of directors 
which— 
(i) is elected by the participating em-
ployers, with each employer having one 
vote; and