[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 5298 Introduced in Senate (IS)]
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118th CONGRESS
2d Session
S. 5298
To amend the Employee Retirement Income Security Act of 1974 to allow
health marketplace pools to be deemed an employer under section 3(5) of
such Act for purposes of offering a group health plan or group health
insurance coverage, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
November 12, 2024
Mr. Paul introduced the following bill; which was read twice and
referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To amend the Employee Retirement Income Security Act of 1974 to allow
health marketplace pools to be deemed an employer under section 3(5) of
such Act for purposes of offering a group health plan or group health
insurance coverage, and for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Health Marketplace for All Act of
2024''.
SEC. 2. HEALTH MARKETPLACE POOLS DEEMED AN ``EMPLOYER'' FOR PURPOSES OF
OFFERING GROUP HEALTH PLANS OR GROUP HEALTH INSURANCE
COVERAGE.
(a) Definition of Employer.--Section 3(5) of the Employee
Retirement Income Security Act of 1974 (29 U.S.C. 1002(5)) is amended
by adding at the end the following: ``Such term shall be deemed to
include, for purposes of offering a group health plan (as defined in
section 733(a)(1)) or group health insurance coverage (as defined in
section 733(b)(4)) (which, notwithstanding any other provision of law,
may include such a plan or coverage covering prescription or
nonprescription drugs as the only benefit offered by the plan or
coverage in accordance with section 736(b)(5)(B)), any entity that
meets the requirements under section 736(b).''.
(b) Group Health Plans and Group Health Insurance Coverage.--Part 7
of subtitle B of title I of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1181 et seq.) is amended by adding at the end the
following:
``SEC. 736. HEALTH MARKETPLACE POOLS DEEMED AN `EMPLOYER' FOR PURPOSES
OF OFFERING GROUP HEALTH PLANS OR GROUP HEALTH INSURANCE
COVERAGE.
``(a) In General.--An entity (referred to in this section as a
`health marketplace pool') that meets the requirements under subsection
(b) shall be deemed an employer under section 3(5) for purposes of
offering a group health plan or group health insurance coverage (which,
notwithstanding any other provision of law, may include such a plan or
coverage covering prescription or nonprescription drugs as the only
benefit offered by the plan or coverage in accordance with subsection
(b)(5)(B)).
``(b) Requirements for Health Marketplace Pools.--The requirements
under this subsection are each of the following:
``(1) Organization.--The health marketplace pool shall--
``(A) be formed and maintained in good faith for a
purpose that includes the formation of a risk pool in
order to offer group health insurance coverage or a
group health plan to its members; and
``(B) not condition membership in the health
marketplace pool on any health status-related factor
relating to an individual (including an employee of an
employer or a dependent of an employee).
``(2) Offering group health plans and group health
insurance coverage.--
``(A) Different groups.--
``(i) In general.--The health marketplace
pool, which may be in conjunction with a health
insurance issuer that offers group health
insurance coverage through the health
marketplace pool, shall make available a group
health plan or group health insurance coverage
to all members of the health marketplace pool
(and, in the case of members that are
employers, employees of the employers) at rates
that--
``(I) are established by the health
marketplace pool, or a health insurance
issuer contracting with such health
marketplace pool, on a policy or
product specific basis; and
``(II) subject to sections 701 and
702, may vary for individuals covered
through the health marketplace pool.
``(ii) Permissible coverage for
dependents.--Such group health plan or group
health insurance coverage may be made available
under clause (i) to any dependents of members
of the health marketplace pool or dependents of
employees of employers that are such members.
``(B) Nondiscrimination in coverage offered.--
``(i) In general.--Subject to clause (ii),
the health marketplace pool may not offer
coverage under a group health plan or group
health insurance coverage to a member of the
health marketplace pool unless the same
coverage is offered to all such members of the
health marketplace pool.
``(ii) Construction.--Nothing in this
subsection shall be construed as requiring a
health insurance issuer or group health plan to
provide coverage outside the service area of
the issuer or plan, or preventing a health
insurance issuer or group health plan from
underwriting or from excluding or limiting the
coverage on any individual, subject to the
requirements under sections 701 and 702.
``(C) Assumption of risk.--The health marketplace
pool may provide--
``(i) group health insurance coverage
through a contract with a health insurance
issuer; or
``(ii) a group health plan through self-
insurance.
``(3) Geographic areas.--Nothing in this subsection shall
be construed as preventing the establishment and operation of
more than 1 health marketplace pool in a geographic area or as
limiting the number of health marketplace pools that may
operate in any area.
``(4) Provision of administrative services to purchasers.--
The health marketplace pool may provide administrative services
for members. Such services may include accounting, billing, and
enrollment information.
``(5) Drug coverage.--The group health plan or group health
insurance coverage offered by the health marketplace pool may
offer--
``(A) drug coverage, including coverage of over-
the-counter drugs, in combination with other benefits
covered by the group health plan or group health
insurance coverage; or
``(B) notwithstanding any other provision of law,
drug coverage, including coverage of over-the-counter
drugs, as the only benefit covered by the group health
plan or group health insurance coverage.
``(6) Members.--
``(A) In general.--With respect to an individual
who is a member of the health marketplace pool--
``(i) the individual may enroll for
coverage under the group health plan or group
health insurance coverage offered by the health
marketplace pool (including, if applicable,
enrollment for coverage for a dependent of such
individual); or
``(ii) the employer of the individual may
enroll the individual for coverage under the
group health plan or group health insurance
coverage offered by the health marketplace pool
(including, if applicable, enrollment for
coverage for a dependent of such individual).
``(B) Eligibility.--An individual shall be eligible
to be a member of the health marketplace pool if such
individual is--
``(i) a member of an entity that
establishes or joins the health marketplace
pool (or a dependent of such a member, as
applicable);
``(ii) an employee of a member of an entity
described in clause (i) (or a dependent of such
an employee, as applicable); or
``(iii) an employee of an entity (or a
dependant of such an employee, as applicable)
controlled by a member of an entity described
in clause (i).
``(C) Rules for enrollment.--Nothing in this
paragraph shall preclude the health marketplace pool
from establishing rules of enrollment and reenrollment
of members. Such rules shall be applied consistently to
all members within the health marketplace pool and
shall not be based in any manner on health status-
related factors in accordance with sections 701 and
702.
``(c) Determination of Employer and Joint Employer Status.--
Participating in or facilitating a group health plan or group health
insurance coverage under this section shall not be construed as
establishing under any Federal or State law--
``(1) an employer relationship for any purpose other than
offering the group health plan or group health insurance
coverage; or
``(2) a joint employer relationship for any purpose.
``(d) Definition.--In this section, the term `dependent', as
applied to a group health plan or group health insurance coverage
offered in a State, shall have the meaning applied to such term with
respect to such plan or coverage under the State law applying to such
plan or coverage. Such term may include the spouse and children of the
individual involved in accordance with such State law.''.
SEC. 3. CONFORMING AMENDMENTS.
Section 3 of the Employee Retirement Income Security Act of 1974
(29 U.S.C. 1002) is amended--
(1) in paragraph (6), by inserting before the period ``,
except (with respect to an entity meeting the requirements
under section 736(b)) such term includes any member of such
entity'';
(2) in paragraph (21)--
(A) in subparagraph (A), by striking ``subparagraph
(B)'' and inserting ``subparagraphs (B) and (C)''; and
(B) by adding at the end the following:
``(C) With respect to a person that is a member of an entity
(referred to in section 736 and this subparagraph as a `health
marketplace pool') that meets the requirements of section 736(b) and
offers a group health plan (as defined in section 733(a)(1)) or group
health insurance coverage (as defined in section 733(b)(4)) (which,
notwithstanding any other provision of law, may include such a plan or
coverage covering prescription or nonprescription drugs as the only
benefit offered by the plan or coverage), membership in the health
marketplace pool shall not by itself cause the person to be a fiduciary
with respect to the group health plan or group health insurance
coverage.''; and
(3) in paragraph (40)(A)--
(A) in clause (ii), by striking ``, or'' and
inserting ``,'';
(B) in clause (iii), by striking the period and
inserting ``, or''; and
(C) by adding at the end the following:
``(iv) as a group health plan (as defined in section
733(a)(1)), or group health insurance coverage (as defined in
section 733(b)(4)), offered by an entity meeting the
requirements under section 736(b) (which, notwithstanding any
other provision of law, may include such an entity offering
such a plan or coverage covering prescription or
nonprescription drugs as the only benefit offered by the plan
or coverage).''.
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