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SECTION 1. SHORT TITLE.

This Act may be cited as the ''Health Care Access and Availability
Act of 2005''.

SEC. 2. CONSTITUTIONAL AUTHORITY.

The constitutional authority upon which this Act rests is the power
of Congress to regulate commerce with foreign nations and among the
several States, set forth in article I, section 8 of the United States
Constitution.

SEC. 3. EXPANSION OF ACCESS AND CHOICE THROUGH INDIVIDUAL MEMBERSHIP
ASSOCIATIONS (IMAS).

The Public Health Service Act is amended by adding at the end the
following new title:

''TITLE XXIX--INDIVIDUAL MEMBERSHIP ASSOCIATIONS

''SEC. 2901. DEFINITION OF INDIVIDUAL MEMBERSHIP ASSOCIATION (IMA).

''(a) In General.--For purposes of this title, the terms
'individual membership association' and 'IMA' mean a legal entity that
meets the following requirements:
''(1) Organization.--The IMA is an organization operated
under the direction of an association (as defined in section
2904(1)).
''(2) Offering health benefits coverage.--
''(A) Different groups.--The IMA, in conjunction
with those health insurance issuers that offer health
benefits coverage through the IMA, makes available
health benefits coverage in the manner described in
subsection (b) to all members of the IMA and the
dependents of such members in the manner described in
subsection (c)(2) at rates that are established by the
health insurance issuer on a policy or product specific
basis and that may vary only as permissible under State
law.
''(B) Nondiscrimination in coverage offered.--
''(i) In general.--Subject to clause (ii),
the IMA may not offer health benefits coverage
to a member of an IMA unless the same coverage
is offered to all such members of the IMA.
''(ii) Construction.--Nothing in this title
shall be construed as requiring or permitting a
health insurance issuer to provide coverage
outside the service area of the issuer, as
approved under State law, or requiring a health
insurance issuer from excluding or limiting the
coverage on any individual, subject to the
requirement of section 2741.
''(C) No financial underwriting.--The IMA provides
health benefits coverage only through contracts with
health insurance issuers and does not assume insurance
risk with respect to such coverage.
''(3) Geographic areas.--Nothing in this title shall be
construed as preventing the establishment and operation of more
than one IMA in a geographic area or as limiting the number of
IMAs that may operate in any area.
''(4) Provision of administrative services to purchasers.--
''(A) In general.--The IMA may provide
administrative services for members. Such services may
include accounting, billing, and enrollment
information.
''(B) Construction.--Nothing in this subsection
shall be construed as preventing an IMA from serving as
an administrative service organization to any entity.
''(5) Filing information.--The IMA files with the Secretary
information that demonstrates the IMA's compliance with the
applicable requirements of this title.
''(b) Health Benefits Coverage Requirements.--
''(1) Compliance with consumer protection requirements.--
Any health benefits coverage offered through an IMA shall--
''(A) be underwritten by a health insurance issuer
that--
''(i) is licensed (or otherwise regulated)
under State law,
''(ii) meets all applicable State standards
relating to consumer protection, subject to
section 2902, and
''(B) subject to paragraph (2), be approved or
otherwise permitted to be offered under State law.
''(2) Examples of types of coverage.--The benefits coverage
made available through an IMA may include, but is not limited
to, any of the following if it meets the other applicable
requirements of this title:
''(A) Coverage through a health maintenance
organization.
''(B) Coverage in connection with a preferred
provider organization.
''(C) Coverage in connection with a licensed
provider-sponsored organization.
''(D) Indemnity coverage through an insurance
company.
''(E) Coverage offered in connection with a
contribution into a medical savings account or flexible
spending account.
''(F) Coverage that includes a point-of-service
option.
''(G) Any combination of such types of coverage.
''(3) Wellness bonuses for health promotion.--Nothing in
this title shall be construed as precluding a health insurance
issuer offering health benefits coverage through an IMA from
establishing premium discounts or rebates for members or from
modifying otherwise applicable copayments or deductibles in
return for adherence to programs of health promotion and
disease prevention so long as such programs are agreed to in
advance by the IMA and comply with all other provisions of this
title and do not discriminate among similarly situated members.
''(c) Members; Health Insurance Issuers.--
''(1) Members.--
''(A) In general.--Under rules established to carry
out this title, with respect to an individual who is a
member of an IMA, the individual may enroll for health
benefits coverage (including coverage for dependents of
such individual) offered by a health insurance issuer
through the IMA.
''(B) Rules for enrollment.--Nothing in this
paragraph shall preclude an IMA from establishing rules
of enrollment and reenrollment of members. Such rules
shall be applied consistently to all members within the
IMA and shall not be based in any manner on health
status-related factors.
''(2) Health insurance issuers.--The contract between an
IMA and a health insurance issuer shall provide, with respect
to a member enrolled with health benefits coverage offered by
the issuer through the IMA, for the payment of the premiums
collected by the issuer.

''SEC. 2902. APPLICATION OF CERTAIN LAWS AND REQUIREMENTS.

''State laws insofar as they relate to any of the following are
superseded and shall not apply to health benefits coverage made
available through an IMA:
''(1) Benefit requirements for health benefits coverage
offered through an IMA, including (but not limited to)
requirements relating to coverage of specific providers,
specific services or conditions, or the amount, duration, or
scope of benefits, but not including requirements to the extent
required to implement title XXVII or other Federal law and to
the extent the requirement prohibits an exclusion of a specific
disease from such coverage.
''(2) Any other requirements (including limitations on
compensation arrangements) that, directly or indirectly,
preclude (or have the effect of precluding) the offering of
such coverage through an IMA, if the IMA meets the requirements
of this title.

''SEC. 2903. ADMINISTRATION.

''(a) In General.--The Secretary shall administer this title and is
authorized to issue such regulations as may be required to carry out
this title. Such regulations shall be subject to Congressional review
under the provisions of chapter 8 of title 5, United States Code. The
Secretary shall incorporate the process of 'deemed file and use' with
respect to the information filed under section 2901(a)(5) and shall
determine whether information filed by an IMA demonstrates compliance
with the applicable requirements of this title. The Secretary shall
exercise authority under this title in a manner that fosters and
promotes the development of IMAs in order to improve access to health
care coverage and services.
''(b) Periodic Reports.--The Secretary shall submit to Congress a
report every 30 months, during the 10-year period beginning on the
effective date of the rules promulgated by the Secretary to carry out
this title, on the effectiveness of this title in promoting coverage of
uninsured individuals. The Secretary may provide for the production of
such reports through one or more contracts with appropriate private
entities.

''SEC. 2904. DEFINITIONS.

''For purposes of this title:
''(1) Association.--The term 'association' means, with
respect to health insurance coverage offered in a State, an
association which--
''(A) has been actively in existence for at least 5
years;
''(B) has been formed and maintained in good faith
for purposes other than obtaining insurance;
''(C) does not condition membership in the
association on any health status-related factor
relating to an individual (including an employee of an
employer or a dependent of an employee); and
''(D) does not make health insurance coverage
offered through the association available other than in
connection with a member of the association.
''(2) Dependent.--The term 'dependent', as applied to
health insurance coverage offered by a health insurance issuer
licensed (or otherwise regulated) in a State, shall have the
meaning applied to such term with respect to such coverage
under the laws of the State relating to such coverage and such
an issuer. Such term may include the spouse and children of the
individual involved.
''(3) Health benefits coverage.--The term 'health benefits
coverage' has the meaning given the term health insurance
coverage in section 2791(b)(1).
''(4) Health insurance issuer.--The term 'health insurance
issuer' has the meaning given such term in section 2791(b)(2).
''(5) Health status-related factor.--The term 'health
status-related factor' has the meaning given such term in
section 2791(d)(9).
''(6) Ima; individual membership association.--The terms
'IMA' and 'individual membership association' are defined in
section 2901(a).
''(7) Member.--The term 'member' means, with respect to an
IMA, an individual who is a member of the association to which
the IMA is offering coverage.''.
Output:
Health Care Access and Availability Act of 2005 - Amends the Public Health Service Act to provide for health benefits coverage through individual membership associations (IMAs), which are organizations operated under the direction of an association that: (1) has been in existence for at least five years; (2) was formed for purposes other than obtaining insurance; and (3) does not condition membership on any health status-related factor.

Prohibits an IMA from offering health benefits coverage to any member unless the same coverage is offered to all members of the IMA.

Provides that the IMA shall provide health benefits coverage only through contracts with health insurance issuers and shall not assume insurance risk with respect to such coverage. Allows an IMA to provide administrative services for members, including accounting, billings, and enrollment information.

Requires an IMA to file with the Secretary of Health and Human Services information that demonstrates the IMA's compliance with the requirements of this Act.

Requires that health benefits coverage offered through an IMA be: (1) underwritten by a health insurance issuer that is licensed under state law and meets all state standards relating to consumer protection; and (2) approved or otherwise be permitted under state law.