Self-Insurance Protection Act

IB Union Calendar No. 88 118TH CONGRESS 1ST SESSION H. R. 2813 [Report No. 118–114, Part I] 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 JUNE 20, 2023 Additional sponsor: Mr. SMUCKER JUNE 20, 2023 Reported from the Committee on Education and the Workforce with an amendment [Strike out all after the enacting clause and insert the part printed in italic] VerDate Sep 11 2014 23:58 Jun 20, 2023 Jkt 039200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H2813.RH H2813 kjohnson on DSK79L0C42PROD with BILLS 2 •HR 2813 RH JUNE 20, 2023 Committees on Energy and Commerce and Ways and Means discharged; com- mitted 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 April 25, 2023] 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. VerDate Sep 11 2014 23:58 Jun 20, 2023 Jkt 039200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H2813.RH H2813 kjohnson on DSK79L0C42PROD with BILLS 3 •HR 2813 RH Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Self-Insurance Protec- 4 tion Act’’. 5 SEC. 2. FINDINGS. 6 Congress finds the following: 7 (1) Small and large employers offer health ben- 8 efit plan coverage to employees in self-funded arrange- 9 ments using company assets or a fund, or by paying 10 premiums to purchase fully-insured coverage from a 11 health insurance company. 12 (2) Employers that self-fund health benefit plans 13 will often purchase stop-loss insurance as a financial 14 risk management tool to protect against excess or un- 15 expected catastrophic health plan claims losses that 16 arise above projected costs paid out of company as- 17 sets. 18 (3) Stop-loss coverage insures the employer spon- 19 soring the health benefit plan against unforeseen 20 health plan claims, does not insure the employee 21 health benefit plan itself, and does not pay health 22 care providers for medical services provided to the 23 employees. 24 VerDate Sep 11 2014 23:58 Jun 20, 2023 Jkt 039200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H2813.RH H2813 kjohnson on DSK79L0C42PROD with BILLS 4 •HR 2813 RH (4) Employer-sponsored health benefit plans are 1 regulated under the Employee Retirement Income Se- 2 curity Act of 1974, however, States regulate the avail- 3 ability and the coverage terms of stop-loss insurance 4 coverage that employers purchase to protect company 5 assets and to protect a fund against excess or unex- 6 pected claims losses. 7 (5) Both large and small employers that choose 8 to self-fund must also be able to protect company as- 9 sets or a fund against excess or unexpected claims 10 losses and States must reasonably regulate stop-loss 11 insurance to assure its availability to both large and 12 small employers. 13 SEC. 3. CERTAIN MEDICAL STOP-LOSS INSURANCE OB- 14 TAINED BY CERTAIN PLAN SPONSORS OF 15 GROUP HEALTH PLANS NOT INCLUDED 16 UNDER THE DEFINITION OF HEALTH INSUR- 17 ANCE COVERAGE. 18 Section 733(b)(1) of the Employee Retirement Income 19 Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is amended 20 by adding at the end the following sentence: ‘‘Such term 21 shall not include a stop-loss policy obtained by a self-in- 22 sured group health plan or a plan sponsor of a group health 23 plan that self-insures the health risks of its plan partici- 24 pants to reimburse the plan or sponsor for losses that the 25 VerDate Sep 11 2014 23:58 Jun 20, 2023 Jkt 039200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H2813.RH H2813 kjohnson on DSK79L0C42PROD with BILLS 5 •HR 2813 RH plan or sponsor incurs in providing health or medical bene- 1 fits to such plan participants in excess of a predetermined 2 level set forth in the stop-loss policy obtained by such plan 3 or sponsor.’’. 4 SEC. 4. EFFECT ON OTHER LAWS. 5 Section 514(b) of the Employee Retirement Income Se- 6 curity Act of 1974 (29 U.S.C. 1144(b)) is amended by add- 7 ing at the end the following: 8 ‘‘(10) The provisions of this title (including part 7 re- 9 lating to group health plans) shall preempt State laws inso- 10 far as they may now or hereafter prevent an employee ben- 11 efit plan that is a group health plan from insuring against 12 the risk of excess or unexpected health plan claims losses.’’. 13 Amend the title so as to read: ‘‘A bill to amend the Employee Retirement Income Security Act of 1974 to ex- clude from the definition of health insurance coverage certain medical stop-loss insurance obtained by certain plan sponsors of group health plans, and for other pur- poses.’’. VerDate Sep 11 2014 23:58 Jun 20, 2023 Jkt 039200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2813.RH H2813 kjohnson on DSK79L0C42PROD with BILLS Union Calendar No. 88 118TH CONGRESS 1ST SESSION H. R. 2813 [Report No. 118–114, Part I] A BILL To amend the Employee Retirement Income Secu- rity Act of 1974, the Public Health Service Act, and the Internal Revenue Code of 1986 to ex- clude from the definition of health insurance cov- erage certain medical stop-loss insurance ob- tained by certain plan sponsors of group health plans, and for other purposes. JUNE 20, 2023 Reported from the Committee on Education and the Workforce with an amendment JUNE 20, 2023 Committees on Energy and Commerce and Ways and Means discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed VerDate Sep 11 2014 23:58 Jun 20, 2023 Jkt 039200 PO 00000 Frm 00006 Fmt 6651 Sfmt 6651 E:\BILLS\H2813.RH H2813 kjohnson on DSK79L0C42PROD with BILLS