| Home > 106th Congressional Bills > H.R. 660 (enr) For the private relief of Ruth Hairston by waiver of a filing deadline for appeal from a ruling relating to her application for a survivor annuity. [Enrolled bill] ...
H.R. 660 (enr) For the private relief of Ruth Hairston by waiver of a filing deadline for appeal from a ruling relating to her application for a survivor annuity. [Enrolled bill] ...
108th CONGRESS 1st Session H. R. 660 _______________________________________________________________________ AN ACT To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. 108th CONGRESS 1st Session H. R. 660 _______________________________________________________________________ AN ACT To amend title I of the Employee Retirement Income Security Act of 1974 to improve access and choice for entrepreneurs with small businesses with respect to medical care for their employees. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. (a) Short Title.--This Act may be cited as the ``Small Business Health Fairness Act of 2003''. (b) Table of Contents.--The table of contents is as follows: Sec. 1. Short title and table of contents. Sec. 2. Rules governing association health plans. Sec. 3. Clarification of treatment of single employer arrangements. Sec. 4. Enforcement provisions relating to association health plans. Sec. 5. Cooperation between Federal and State authorities. Sec. 6. Effective date and transitional and other rules. SEC. 2. RULES GOVERNING ASSOCIATION HEALTH PLANS. (a) In General.--Subtitle B of title I of the Employee Retirement Income Security Act of 1974 is amended by adding after part 7 the following new part: ``Part 8--Rules Governing Association Health Plans ``SEC. 801. ASSOCIATION HEALTH PLANS. ``(a) In General.--For purposes of this part, the term `association health plan' means a group health plan whose sponsor is (or is deemed under this part to be) described in subsection (b). ``(b) Sponsorship.--The sponsor of a group health plan is described in this subsection if such sponsor-- ``(1) is organized and maintained in good faith, with a constitution and bylaws specifically stating its purpose and providing for periodic meetings on at least an annual basis, as a bona fide trade association, a bona fide industry association (including a rural electric cooperative association or a rural telephone cooperative association), a bona fide professional association, or a bona fide chamber of commerce (or similar bona fide business association, including a corporation or similar organization that operates on a cooperative basis (within the meaning of section 1381 of the Internal Revenue Code of 1986)), for substantial purposes other than that of obtaining or providing medical care; ``(2) is established as a permanent entity which receives the active support of its members and requires for membership payment on a periodic basis of dues or payments necessary to maintain eligibility for membership in the sponsor; and ``(3) does not condition membership, such dues or payments, or coverage under the plan on the basis of health status- related factors with respect to the employees of its members (or affiliated members), or the dependents of such employees, and does not condition such dues or payments on the basis of group health plan participation. Any sponsor consisting of an association of entities which meet the requirements of paragraphs (1), (2), and (3) shall be deemed to be a sponsor described in this subsection. ``SEC. 802. CERTIFICATION OF ASSOCIATION HEALTH PLANS. ``(a) In General.--The applicable authority shall prescribe by regulation a procedure under which, subject to subsection (b), the applicable authority shall certify association health plans which apply for certification as meeting the requirements of this part. ``(b) Standards.--Under the procedure prescribed pursuant to subsection (a), in the case of an association health plan that provides at least one benefit option which does not consist of health insurance coverage, the applicable authority shall certify such plan as meeting the requirements of this part only if the applicable authority is satisfied that the applicable requirements of this part are met (or, upon the date on which the plan is to commence operations, will be met) with respect to the plan. ``(c) Requirements Applicable to Certified Plans.--An association health plan with respect to which certification under this part is in effect shall meet the applicable requirements of this part, effective on the date of certification (or, if later, on the date on which the plan is to commence operations). ``(d) Requirements for Continued Certification.--The applicable authority may provide by regulation for continued certification of association health plans under this part. ``(e) Class Certification for Fully Insured Plans.--The applicable authority shall establish a class certification procedure for association health plans under which all benefits consist of health insurance coverage. Under such procedure, the applicable authority shall provide for the granting of certification under this part to the plans in each class of such association health plans upon appropriate filing under such procedure in connection with plans in such class and payment of the prescribed fee under section 807(a). ``(f) Certification of Self-Insured Association Health Plans.--An association health plan which offers one or more benefit options which do not consist of health insurance coverage may be certified under this part only if such plan consists of any of the following: ``(1) a plan which offered such coverage on the date of the enactment of the Small Business Health Fairness Act of 2003, ``(2) a plan under which the sponsor does not restrict membership to one or more trades and businesses or industries and whose eligible participating employers represent a broad cross-section of trades and businesses or industries, or ``(3) a plan whose eligible participating employers represent one or more trades or businesses, or one or more industries, consisting of any of the following: agriculture; equipment and automobile dealerships; barbering and cosmetology; certified public accounting practices; child care; construction; dance, theatrical and orchestra productions; disinfecting and pest control; financial services; fishing; foodservice establishments; hospitals; labor organizations; logging; manufacturing (metals); mining; medical and dental practices; medical laboratories; professional consulting services; sanitary services; transportation (local and freight); warehousing; wholesaling/distributing; or any other trade or business or industry which has been indicated as having average or above-average risk or health claims experience by reason of State rate filings, denials of coverage, proposed premium rate levels, or other means demonstrated by such plan in accordance with regulations. ``SEC. 803. REQUIREMENTS RELATING TO SPONSORS AND BOARDS OF TRUSTEES. ``(a) Sponsor.--The requirements of this subsection are met with respect to an association health plan if the sponsor has met (or is deemed under this part to have met) the requirements of section 801(b) for a continuous period of not less than 3 years ending with the date of the application for certification under this part. ``(b) Board of Trustees.--The requirements of this subsection are met with respect to an association health plan if the following requirements are met: ``(1) Fiscal control.--The plan is operated, pursuant to a trust agreement, by a board of trustees which has complete fiscal control over the plan and which is responsible for all operations of the plan. ``(2) Rules of operation and financial controls.--The board of trustees has in effect rules of operation and financial controls, based on a 3-year plan of operation, adequate to carry out the terms of the plan and to meet all requirements of this title applicable to the plan. ``(3) Rules governing relationship to participating employers and to contractors.-- ``(A) Board membership.-- ``(i) In general.--Except as provided in clauses (ii) and (iii), the members of the board of trustees are individuals selected from individuals who are the owners, officers, directors, or employees of the participating employers or who are partners in the participating employers and actively participate in the business. ``(ii) Limitation.-- ``(I) General rule.--Except as provided in subclauses (II) and (III), no such member is an owner, officer, director, or employee of, or partner in, a contract administrator or other service provider to the plan. ``(II) Limited exception for providers of services solely on behalf of the sponsor.--Officers or employees of a sponsor which is a service provider (other than a contract administrator) to the plan may be members of the board if they constitute not more than 25 percent of the membership of the board and they do not provide services to the plan other than on behalf of the sponsor. ``(III) Treatment of providers of medical care.--In the case of a sponsor which is an association whose membership consists primarily of providers of medical care, subclause (I) shall not apply in the case of any service provider described in subclause (I) who is a provider of medical care under the plan. ``(iii) Certain plans excluded.--Clause (i) shall not apply to an association health plan which is in existence on the date of the enactment of the Small Business Health Fairness Act of 2003. ``(B) Sole authority.--The board has sole authority under the plan to approve applications for participation in the plan and to contract with a service provider to administer the day-to-day affairs of the plan. ``(c) Treatment of Franchise Networks.--In the case of a group health plan which is established and maintained by a franchiser for a franchise network consisting of its franchisees-- ``(1) the requirements of subsection (a) and section 801(a) shall be deemed met if such requirements would otherwise be met if the franchiser were deemed to be the sponsor referred to in section 801(b), such network were deemed to be an association described in section 801(b), and each franchisee were deemed to be a member (of the association and the sponsor) referred to in section 801(b); and ``(2) the requirements of section 804(a)(1) shall be deemed met. The Secretary may by regulation define for purposes of this subsection the terms `franchiser', `franchise network', and `franchisee'. ``SEC. 804. PARTICIPATION AND COVERAGE REQUIREMENTS. ``(a) Covered Employers and Individuals.--The requirements of this subsection are met with respect to an association health plan if, under the terms of the plan-- ``(1) each participating employer must be-- ``(A) a member of the sponsor, ``(B) the sponsor, or ``(C) an affiliated member of the sponsor with respect to which the requirements of subsection (b) are met, except that, in the case of a sponsor which is a professional association or other individual-based association, if at least one of the officers, directors, or employees of an employer, or at least one of the individuals who are partners in an employer and who actively participates in the business, is a member or such an affiliated member of the sponsor, participating employers may also include such employer; and ``(2) all individuals commencing coverage under the plan after certification under this part must be-- ``(A) active or retired owners (including self- employed individuals), officers, directors, or employees of, or partners in, participating employers; or ``(B) the beneficiaries of individuals described in subparagraph (A). ``(b) Coverage of Previously Uninsured Employees.--In the case of an association health plan in existence on the date of the enactment of the Small Business Health Fairness Act of 2003, an affiliated member of the sponsor of the plan may be offered coverage under the plan as a participating employer only if-- ``(1) the affiliated member was an affiliated member on the date of certification under this part; or ``(2) during the 12-month period preceding the date of the offering of such coverage, the affiliated member has not maintained or contributed to a group health plan with respect to any of its employees who would otherwise be eligible to participate in such association health plan. ``(c) Individual Market Unaffected.--The requirements of this subsection are met with respect to an association health plan if, under the terms of the plan, no participating employer may provide health insurance coverage in the individual market for any employee not covered under the plan which is similar to the coverage contemporaneously provided to employees of the employer under the plan, if such exclusion of the employee from coverage under the plan is based on a health status-related factor with respect to the employee and such employee would, but for such exclusion on such basis, be eligible for
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