Association Health Plans Act

Inclusion of Self-Employed Individuals: The bill allows self-employed individuals—defined as those with a bona fide ownership right who work at least 10 hours a week—to be treated as both an employer and an employee within these groups (Section 2(c)).

Protection Against Health Status Discrimination: The bill prohibits these plans from denying coverage based on pre-existing conditions or discriminating against individuals regarding enrollment and premiums based on health status-related factors (Section 3(b)).

Flexible Premium Rating: Groups can establish base premium rates using a modified community rating methodology that considers the pooling of all participant claims (Section 3(a)(1)(A)(i)).

Employer-Specific Adjustments: The act allows for the adjustment of contribution rates for specific employer members based on their specific risk profile (Section 3(a)(1)(A)(ii)).

Standardized Rates for Self-Employed Groups: If a group consists entirely of self-employed individuals, the plan must treat them as a single risk pool and charge every participant the same premium rate (Section 3(a)(2)).

Membership Limitations: Coverage under these plans is strictly limited to employees of employer members or the self-employed individuals themselves, meaning coverage cannot be provided to anyone else (Section 2(a)(B)(vii)).

Restrictions on Group Formation: To qualify, a group or association must be formed for purposes other than just providing medical care through insurance or otherwise (Section 2(a)(B)(iv)).

Membership Denial Based on Board Determination: A group's governing board has the authority to determine if an individual meets the requirements to be a member and can stop providing coverage if those requirements are no longer met (Section 2(c)(iii)).