Association Health Plans Act

Expanded Access for Diverse Businesses: Groups or associations can sponsor group health plans regardless of whether the member employers are in the same industry, trade, or profession (Section 2(a)).

Inclusion of Self-Employed Individuals: Self-employed individuals who meet specific ownership and work hour requirements can be treated as employers and employees, allowing them to participate in these group health plans (Section 2(a)(C)).

Health Status Protections: The bill prohibits plans from using health status-related factors to determine eligibility for enrollment or continued enrollment (Section 3(a)(b)(1)).

Fair Pricing Protections: Plans are prohibited from charging individuals higher premiums or contributions than similarly situated individuals based on health status-related factors (Section 3(a)(b)(2)).

Pre-Existing Condition Coverage: The bill prohibits the denial of coverage based on a pre-existing condition (Section 3(a)(b)(3)).

Eligibility Monitoring for Self-Employed: Self-employed individuals are subject to periodic monitoring by the association board, and coverage can be removed if the board determines they no longer meet the requirements (Section 2(a)(C)(iii)).

Risk-Based Premium Adjustments: The bill allows plans to use the specific risk profile of each employer member to adjust contribution rates above or below base premium rates (Section 3(a)(a)(1)(ii)).