[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2813 Introduced in House (IH)]
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118th CONGRESS
1st Session
H. R. 2813
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.
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IN THE HOUSE OF REPRESENTATIVES
April 25, 2023
Mr. Good of Virginia (for himself and Mr. Walberg) introduced the
following 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
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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.
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 ``Self-Insurance Protection Act''.
SEC. 2. FINDINGS.
Congress finds the following:
(1) Small and large employers offer health benefit plan
coverage to employees in self-funded arrangements using company
assets or a fund, or by paying premiums to purchase fully-
insured coverage from a health insurance company.
(2) Employers that self-fund health benefit plans will
often purchase stop-loss insurance as a financial risk
management tool to protect against excess or unexpected
catastrophic health plan claims losses that arise above
projected costs paid out of company assets.
(3) Stop-loss coverage insures the employer sponsoring the
health benefit plan against unforeseen health plan claims, does
not insure the employee health benefit plan itself, and does
not pay health care providers for medical services provided to
the employees.
(4) Employer-sponsored health benefit plans are regulated
under the Employee Retirement Income Security Act of 1974,
however, States regulate the availability and the coverage
terms of stop-loss insurance coverage that employers purchase
to protect company assets and to protect a fund against excess
or unexpected claims losses.
(5) Both large and small employers that choose to self-fund
must also be able to protect company assets or a fund against
excess or unexpected claims losses and States must reasonably
regulate stop-loss insurance to assure its availability to both
large and small employers.
SEC. 3. CERTAIN MEDICAL STOP-LOSS INSURANCE OBTAINED BY CERTAIN PLAN
SPONSORS OF GROUP HEALTH PLANS NOT INCLUDED UNDER THE
DEFINITION OF HEALTH INSURANCE COVERAGE.
(a) ERISA.--Section 733(b)(1) of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1191b(b)(1)) is amended by adding at
the end the following sentence: ``Such term shall not include a stop-
loss policy obtained by a self-funded health plan or a plan sponsor of
a group health plan that self-funds the health risks of its plan
participants to reimburse the plan or sponsor for losses that the plan
or sponsor incurs in providing health or medical benefits to such plan
participants in excess of a predetermined level set forth in the stop-
loss policy obtained by such plan or sponsor.''.
(b) PHSA.--Section 2791(b)(1) of the Public Health Service Act (42
U.S.C. 300gg-91(b)(1)) is amended by adding at the end the following
new sentence: ``Such term shall not include a stop-loss policy obtained
by a self-funded health plan or a plan sponsor of a group health plan
that self-funds the health risks of its plan participants to reimburse
the plan or sponsor for losses that the plan or sponsor incurs in
providing health or medical benefits to such plan participants in
excess of a predetermined level set forth in the stop-loss policy
obtained by such plan or sponsor.''.
(c) IRC.--Section 9832(b)(1)(A) of the Internal Revenue Code of
1986 is amended by adding at the end the following new sentence: ``Such
term shall not include a stop-loss policy obtained by a self-funded
health plan or a plan sponsor of a group health plan that self-funds
the health risks of its plan participants to reimburse the plan or
sponsor for losses that the plan or sponsor incurs in providing health
or medical benefits to such plan participants in excess of a
predetermined level set forth in the stop-loss policy obtained by such
plan or sponsor.''.
SEC. 4. EFFECT ON OTHER LAWS.
Section 514(b) of the Employee Retirement Income Security Act of
1974 (29 U.S.C. 1144(b)) is amended by adding at the end the following:
``(10) The provisions of this title (including part 7 relating to
group health plans) shall preempt State laws insofar as they may now or
hereafter prevent an employee benefit plan that is a group health plan
from insuring against the risk of excess or unexpected health plan
claims losses.''.
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