IB 
★★
Union Calendar No. 493 
114TH CONGRESS 
2D SESSION 
H. R. 5447 
[Report No. 114–634, Part I] 
To provide an exception from certain group health plan requirements for 
qualified small employer health reimbursement arrangements. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 10, 2016 
Mr. BOUSTANY (for himself and Mr. THOMPSON of California) introduced the 
following bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committees on Education and the Workforce and 
Energy and Commerce, 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 
JUNE 21, 2016 
Additional sponsors: Mrs. NOEM, Mr. MEEHAN, Mr. DOLD, Mr. TIBERI, Mr. 
ROSKAM, Mr. PAULSEN, Mr. HOLDING, Mr. KELLY of Pennsylvania, Mr. 
NUNES, Mr. TOM PRICE of Georgia, Mr. MARCHANT, Mr. BUCHANAN, 
Mr. RENACCI, Ms. LINDA T. SA´NCHEZ of California, Mr. PASCRELL, Mr. 
BLUMENAUER, Mr. ASHFORD, Mr. SCHRADER, Ms. ESHOO, Mr. PETER-
SON, Mr. KIND, Mr. LARSON of Connecticut, Mrs. TORRES, Ms. SINEMA, 
Ms. BONAMICI, Mr. HECK of Washington, Mr. BLUM, Mrs. MCMORRIS 
RODGERS, Ms. MCSALLY, Mr. FLORES, Mr. COOPER, Mr. LOWENTHAL, 
Mr. SWALWELL of California, Miss RICE of New York, Mr. KILMER, Mr. 
MULLIN, Mr. HUDSON, Mr. CRAMER, Mr. JOHNSON of Ohio, Mr. COS-
TELLO of Pennsylvania, Mr. BARLETTA, Mr. TURNER, Mr. RIBBLE, Mr. 
CULBERSON, Mr. FORTENBERRY, Mr. ALLEN, Mrs. WALORSKI, Mr. TIP-
TON, Mr. POMPEO, Mr. BISHOP of Michigan, Mr. ROKITA, Mrs. BLACK, 
Mr. STIVERS, Mr. REICHERT, Mr. LIPINSKI, Mr. SMITH of Missouri, Ms. 
DUCKWORTH, and Mr. COURTNEY 
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JUNE 21, 2016 
Reported from the Committee on Ways and Means with an amendment 
[Strike out all after the enacting clause and insert the part printed in italic] 
JUNE 21, 2016 
The Committees on Education and the Workforce and Energy and Commerce 
discharged; committed to the Committee of the Whole House on the State 
of the Union and ordered to be printed 
[For text of introduced bill, see copy of bill as introduced on June 10, 2016] 
A BILL 
To provide an exception from certain group health plan re-
quirements for qualified small employer health reim-
bursement arrangements. 
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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 ‘‘Small Business Health 
Care Relief Act of 2016’’. 
SEC. 2. EXCEPTION FROM GROUP HEALTH PLAN REQUIRE-
MENTS FOR QUALIFIED SMALL EMPLOYER 
HEALTH REIMBURSEMENT ARRANGEMENTS. 
(a) AMENDMENTS TO THE INTERNAL REVENUE CODE 
OF 1986 AND THE PATIENT PROTECTION AND AFFORDABLE 
CARE ACT.— 
(1) IN GENERAL.—Section 9831 of the Internal 
Revenue Code of 1986 is amended by adding at the 
end the following new subsection: 
‘‘(d) EXCEPTION FOR QUALIFIED SMALL EMPLOYER 
HEALTH REIMBURSEMENT ARRANGEMENTS.— 
‘‘(1) IN GENERAL.—For purposes of this title (ex-
cept as provided in section 4980I(f)(4) and notwith-
standing any other provision of this title), the term 
‘group health plan’ shall not include any qualified 
small employer health reimbursement arrangement. 
‘‘(2) QUALIFIED SMALL EMPLOYER HEALTH RE-
IMBURSEMENT ARRANGEMENT.—For purposes of this 
subsection— 
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‘‘(A) IN
GENERAL.—The term ‘qualified 
small employer health reimbursement arrange-
ment’ means an arrangement which— 
‘‘(i) is described in subparagraph (B), 
and 
‘‘(ii) is provided on the same terms to 
all eligible employees of the eligible em-
ployer. 
‘‘(B) ARRANGEMENT
DESCRIBED.—An ar-
rangement is described in this subparagraph if— 
‘‘(i) such arrangement is funded solely 
by an eligible employer and no salary re-
duction contributions may be made under 
such arrangement, 
‘‘(ii) such arrangement provides, after 
the employee provides proof of coverage, for 
the payment of, or reimbursement of, an eli-
gible employee for expenses for medical care 
(as defined in section 213(d)) incurred by 
the eligible employee or the eligible employ-
ee’s family members (as determined under 
the terms of the arrangement), and 
‘‘(iii) the amount of payments and re-
imbursements described in clause (ii) for 
any year do not exceed $5,130 ($10,260 in 
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the case of an arrangement that also pro-
vides for payments or reimbursements for 
family members of the employee). 
‘‘(C) CERTAIN VARIATION PERMITTED.—For 
purposes of subparagraph (A)(ii), an arrange-
ment shall not fail to be treated as provided on 
the same terms to each eligible employee merely 
because the employee’s permitted benefits under 
such arrangement vary in accordance with the 
variation in the price of an insurance policy in 
the relevant individual health insurance market 
based on— 
‘‘(i) the age of the eligible employee 
(and, in the case of an arrangement which 
covers medical expenses of the eligible em-
ployee’s family members, the age of such 
family members), or 
‘‘(ii) the number of family members of 
the eligible employee the medical expenses of 
which are covered under such arrangement. 
The variation permitted under the preceding sen-
tence shall be determined by reference to the 
same insurance policy with respect to all eligible 
employees. 
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‘‘(D) RULES RELATING TO MAXIMUM DOL-
LAR LIMITATION.— 
‘‘(i) AMOUNT
PRORATED
IN
CERTAIN 
CASES.—In the case of an individual who is 
not covered by an arrangement for the en-
tire year, the limitation under subpara-
graph (A)(iii) for such year shall be an 
amount which bears the same ratio to the 
amount which would (but for this clause) be 
in effect for such individual for such year 
under subparagraph (A)(iii) as the number 
of months for which such individual is cov-
ered by the arrangement for such year bears 
to 12. 
‘‘(ii) INFLATION ADJUSTMENT.—In the 
case of any year beginning after 2016, each 
of the dollar amounts in subparagraph 
(A)(iii) shall be increased by an amount 
equal to— 
‘‘(I) such dollar amount, multi-
plied by 
‘‘(II) the cost-of-living adjustment 
determined under section 1(f)(3) for 
the calendar year in which the taxable 
year begins, determined by substituting 
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‘calendar year 2015’ for ‘calendar year 
1992’ in subparagraph (B) thereof. 
If any dollar amount increased under the 
preceding sentence is not a multiple of 
$100, such dollar amount shall be rounded 
to the next lowest multiple of $100. 
‘‘(3) OTHER DEFINITIONS.—For purposes of this 
subsection— 
‘‘(A) ELIGIBLE EMPLOYEE.—The term ‘eli-
gible employee’ means any employee of an eligi-
ble employer, except that the terms of the ar-
rangement may exclude from consideration em-
ployees described in any clause of section 
105(h)(3)(B) (applied by substituting ‘90 days’ 
for ‘3 years’ in clause (i) thereof). 
‘‘(B) ELIGIBLE EMPLOYER.—The term ‘eli-
gible employer’ means an employer that— 
‘‘(i) is not an applicable large em-
ployer as defined in section 4980H(c)(2), 
and 
‘‘(ii) does not offer a group health plan 
to any of its employees. 
‘‘(C) PERMITTED BENEFIT.—The term ‘per-
mitted benefit’ means, with respect to any eligi-
ble employee, the maximum dollar amount of 
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payments and reimbursements which may be 
made under the terms of the qualified small em-
ployer health reimbursement arrangement for the 
year with respect to such employee. 
‘‘(4) NOTICE.— 
‘‘(A) IN GENERAL.—An employer funding a 
qualified small employer health reimbursement 
arrangement for any year shall, not later than 
90 days before the beginning of such year (or, in 
the case of an employee who is not eligible to 
participate in the arrangement as of the begin-
ning of such year, the date on which such em-
ployee is first so eligible), provide a written no-
tice to each eligible employee which includes the 
information described in subparagraph (B). 
‘‘(B) CONTENTS OF NOTICE.—The notice re-
quired under subparagraph (A) shall include 
each of the following: 
‘‘(i) A statement of the amount which 
would be such eligible employee’s permitted 
benefits under the arrangement for the year. 
‘‘(ii) A statement that the eligible em-
ployee should provide the information de-
scribed in clause (i) to any health insurance 
exchange to which the employee applies for 
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advance payment of the premium assistance 
tax credit. 
‘‘(iii) A statement that if the employee 
is not covered under minimum essential 
coverage for any month the employee may 
be subject to tax under section 5000A for 
such month and reimbursements under the 
arrangement may be includible in gross in-
come.’’. 
(2) LIMITATION ON EXCLUSION FROM GROSS IN-
COME.—Section 106 of such Code is amended by add-
ing at the end the following: 
‘‘(g) QUALIFIED SMALL EMPLOYER HEALTH REIM-
BURSEMENT ARRANGEMENT.—For purposes of this section 
and section 105, payments or reimbursements from a quali-
fied small employer health reimbursement arrangement (as 
defined in section 9831(d)) of an individual for medical 
care (as defined in section 213(d)) shall not be treated as 
paid or reimbursed under employer-provided coverage for 
medical expenses under an accident or health plan if for 
the month in which such medical care is provided the indi-
vidual does not have minimum essential coverage (within 
the meaning of section 5000A(f)).’’. 
(3) COORDINATION
WITH
HEALTH
INSURANCE 
PREMIUM CREDIT.—Section 36B(c) of such Code is 
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amended by adding at the end the following new 
paragraph: 
‘‘(4) SPECIAL RULES FOR QUALIFIED SMALL EM-
PLOYER HEALTH REIMBURSEMENT ARRANGEMENTS.— 
‘‘(A) IN
GENERAL.—The term ‘coverage 
month’ shall not include any month with respect 
to an employee (or any spouse or dependent of 
such employee) if for such month the employee is 
provided a qualified small employer health reim-
bursement arrangement which constitutes afford-
able coverage. 
‘‘(B) DENIAL OF DOUBLE BENEFIT.—In the 
case of any employee who is provided a qualified 
small employer health reimbursement arrange-
ment for any coverage month (determined with-
out regard to subparagraph (A)), the credit oth-
erwise allowable under subsection (a) to the tax-
payer for such month shall be reduced (but not 
below zero) by the amount described in subpara-
graph (C)(i)(II) for such month. 
‘‘(C) AFFORDABLE
COVERAGE.—For pur-
poses of subparagraph (A), a qualified small em-
ployer health reimbursement arrangement shall 
be treated as constituting affordable coverage for 
a month if— 
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‘‘(i) the excess of— 
‘‘(I) the amount that would be 
paid by the employee as the premium 
for such month for self-only coverage 
under the second lowest cost silver plan 
offered in the relevant individual 
health insurance market, over 
‘‘(II) 1⁄12 of the employee’s per-
mitted benefit (as defined in section 
9831(d)(3)(C)) under such arrange-
ment, does not exceed— 
‘‘(ii) 1⁄12 of 9.5 percent of the employ-
ee’s household income. 
‘‘(D) QUALIFIED SMALL EMPLOYER HEALTH 
REIMBURSEMENT ARRANGEMENT.—For purposes 
of this paragraph, the term ‘qualified small em-
ployer health reimbursement arrangement’ has 
the meaning given such term by section 
9831(d)(2). 
‘‘(E) COVERAGE
FOR
LESS
THAN
ENTIRE 
YEAR.—In the case of an employee who is pro-
vided a qualified small employer health reim-
bursement arrangement for less than an entire 
year, subparagraph (C)(i)(II) shall be applied by 
substituting ‘the number of months during the 
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year for which such arrangement was provided’ 
for ‘12’. 
‘‘(F) INDEXING.—In the case of plan years 
beginning in any calendar year after 2014, the 
Secretary shall adjust the 9.5 percent amount 
under subparagraph (C)(ii) in the same manner 
as the percentages are adjusted under subsection 
(b)(3)(A)(ii).’’. 
(4) APPLICATION OF EXCISE TAX ON HIGH COST 
EMPLOYER-SPONSORED HEALTH COVERAGE.— 
(A) IN
GENERAL.—Section 4980I(f)(4) of 
such Code is amended by adding at the end the 
following: ‘‘Section 9831(d)(1) shall not apply 
for purposes of this section.’’. 
(B) DETERMINATION
OF
COST
OF
COV-
ERAGE.—Section 4980I(d)(2) of such Code is 
amended by redesignating subparagraph (D) as 
subparagraph (E) and by inserting after sub-
paragraph (C) the following new subparagraph: 
‘‘(D) QUALIFIED SMALL EMPLOYER HEALTH 
REIMBURSEMENT ARRANGEMENTS.—In the case 
of applicable employer-sponsored coverage con-
sisting of coverage under any qualified small em-
ployer health reimbursement arrangement (as de-
fined in section 9831(d)(2)), the cost of coverage 
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shall be equal to the amount described in section 
6051(a)(15).’’. 
(5) ENFORCEMENT OF NOTICE REQUIREMENT.— 
Section 6652 of such Code is amended by adding at 
the end the following new subsection: 
‘‘(o) FAILURE TO PROVIDE NOTICES WITH RESPECT 
TO QUALIFIED SMALL EMPLOYER HEALTH REIMBURSE-
MENT ARRANGEMENTS.—In the case of each failure to pro-
vide a written notice as required by section 9831(d)(4), un-
less it is shown that such failure is due to reasonable cause 
and not willful neglect, there shall be paid, on notice and 
demand of the Secretary and in the same manner as tax, 
by the person failing to provide such written notice, an 
amount equal to $50 per employee per incident of failure 
to provide such notice, but the total amount imposed on 
such person for all such failures during any calendar year 
shall not exceed $2,500.’’. 
(6) REPORTING.— 
(A) W–2 REPORTING.—Section 6051(a) of 
such Code is amended by striking ‘‘and’’ at the 
end of paragraph (13), by striking the period at 
the end of paragraph (14) and inserting ‘‘, and’’, 
and by inserting after paragraph (14) the fol-
lowing new paragraph: 
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‘‘(15) the total amount of permitted benefit (as 
defined in section 9831(d)(3)(C)) for the year under 
a qualified small employer health reimbursement ar-
rangement (as defined in section 9831(d)(2)) with re-
spect to the employee.’’. 
(B) INFORMATION REQUIRED TO BE PRO-
VIDED
BY
EXCHANGE
SUBSIDY
APPLICANTS.— 
Section 1411(b)(3) of the Patient Protection and 
Affordable Care Act is amended by redesignating 
subparagraph (B) as subparagraph (C) and by 
inserting after subparagraph (A) the following 
new subparagraph: 
‘‘(B) CERTAIN INDIVIDUAL HEALTH INSUR-
ANCE POLICIES OBTAINED THROUGH SMALL EM-
PLOYERS.—The amount of the enrollee’s per-
mitted 
benefit 
(as 
defined 
in 
section 
9831(d)(3)(C) of the Internal Revenue Code of 
1986) under a qualified small employer health 
reimbursement arrangement (as defined in sec-
tion 9831(d)(2) of such Code).’’. 
(7) EFFECTIVE DATES.— 
(A) IN GENERAL.—Except as otherwise pro-
vided in this paragraph, the amendments made 
by this subsection shall apply to years beginning 
after the earlier of— 
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(i) the date that is 90 days after the 
date of the enactment of this Act, or 
(ii) December 31, 2016. 
(B) TRANSITION RELIEF.—The relief under 
Treasury Notice 2015–17 shall be treated as ap-
plying to any plan year beginning on or before 
the date described in subparagraph (A). 
(C) COORDINATION WITH HEALTH INSUR-
ANCE PREMIUM CREDIT.—The amendments made 
by paragraph (3) shall apply to taxable years be-
ginning after the date described in subparagraph 
(A). 
(D) EMPLOYEE NOTICE.—The amendments 
made by paragraph (5) shall apply to notices 
with respect to years beginning after the date de-
scribed in subparagraph (A). 
(E) W–2 REPORTING.—The amendments 
made by paragraph (6)(A) shall apply to cal-
endar years beginning after December 31, 2016. 
(F) INFORMATION PROVIDED BY EXCHANGE 
SUBSIDY APPLICANTS.— 
(i) IN
GENERAL.—The amendments 
made by paragraph (6)(B) shall apply to 
applications for enrollment made after the 
date described in subparagraph (A). 
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(ii) VERIFICATION.—Verification under 
section 1411 of the Patient Protection and 
Affordable Care Act of information provided 
under section 1411(b)(3)(B) of such Act 
shall apply with respect to months begin-
ning after October 2016. 
(8) SUBSTANTIATION REQUIREMENTS.—The Sec-
retary of the Treasury (or his designee) may issue 
substantiation requirements as necessary to carry out 
this subsection. 
(b) AMENDMENTS TO THE EMPLOYEE RETIREMENT 
INCOME SECURITY ACT OF 1974.— 
(1) IN GENERAL.—Section 733(a)(1) of the Em-
ployee Retirement Income Security Act of 1974 (29 
U.S.C. 1191b(a)(1)) is amended by adding at the end 
the following: ‘‘Such term shall not include any quali-
fied small employer health reimbursement arrange-
ment (as defined in section 9831(d)(2) of the Internal 
Revenue Code of 1986).’’. 
(2) EXCEPTION FROM CONTINUATION COVERAGE 
REQUIREMENTS, ETC.—Section 607(1) of such Act (29 
U.S.C. 1167(1)) is amended by adding at the end the 
following: ‘‘Such term shall not include any qualified 
small employer health reimbursement arrangement 
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(as defined in section 9831(d)(2) of the Internal Rev-
enue Code of 1986).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to plan years beginning 
after the date described in subsection (a)(7)(A). 
(c) AMENDMENTS TO THE PUBLIC HEALTH SERVICE 
ACT.— 
(1) IN
GENERAL.—Section 2791(a)(1) of the 
Public Health Service Act (42 U.S.C. 300gg–91(a)(1)) 
is amended by adding at the end the following: ‘‘Ex-
cept for purposes of part C of title XI of the Social 
Security Act (42 U.S.C. 1320d et seq.), such term 
shall not include any qualified small employer health 
reimbursement arrangement (as defined in section 
9831(d)(2) of the Internal Revenue Code of 1986).’’. 
(2) EXCEPTION FROM CONTINUATION COVERAGE 
REQUIREMENTS.—Section 2208(1) of the Public 
Health Service Act (42 U.S.C. 300bb–8(1)) is amend-
ed by adding at the end the following: ‘‘Such term 
shall not include any qualified small employer health 
reimbursement arrangement (as defined in section 
9831(d)(2) of the Internal Revenue Code of 1986).’’. 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to plan years beginning 
after the date described in subsection (a)(7)(A). 
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Union Calendar No. 493 
114TH CONGRESS 
2D SESSION 
H. R. 5447 
[Report No. 114–634, Part I] 
A BILL 
To provide an exception from certain group health 
plan requirements for qualified small employer 
health reimbursement arrangements. 
JUNE 21, 2016 
Reported from the Committee on Ways and Means with 
an amendment 
JUNE 21, 2016 
The Committees on Education and the Workforce and 
Energy and Commerce discharged; committed to the 
Committee of the Whole House on the State of the 
Union and ordered to be printed 
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