I 
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 fol-
lowing 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 Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Self-Insurance Protec-
tion Act’’. 
SEC. 2. FINDINGS. 
Congress finds the following: 
(1) Small and large employers offer health ben-
efit plan coverage to employees in self-funded ar-
rangements 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 fi-
nancial risk management tool to protect against ex-
cess 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 unfore-
seen health plan claims, does not insure the em-
ployee 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 in-
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surance 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 as-
sets 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 OB-
TAINED BY CERTAIN PLAN SPONSORS OF 
GROUP 
HEALTH 
PLANS 
NOT 
INCLUDED 
UNDER THE DEFINITION OF HEALTH INSUR-
ANCE COVERAGE. 
(a) ERISA.—Section 733(b)(1) of the Employee Re-
tirement Income Security Act of 1974 (29 U.S.C. 
1191b(b)(1)) is amended by adding at the end the fol-
lowing 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 pro-
viding 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.’’. 
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(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-fund-
ed 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 Rev-
enue 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 partici-
pants 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: 
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‘‘(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.’’. 
Æ 
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