Amendment ID: S3116-53

Amendment 53

Association Health Plans

Mr. Tarr moves that the proposed new draft be amended by inserting after section _ the following sections:-

"SECTION_. Section 1 of chapter 176J as appearing in the 2024 official edition is hereby amended by inserting in line 17 after the word "act" the following definition: -

“Association health plan”, a health benefit plan offered by a bona fide group or association of employers, including sole proprietors and self‑employed individuals, that meets the requirements of this chapter and regulations of the division of insurance.

SECTION_. Said chapter 176J is hereby further amended by inserting after section 12 the following section: 12A.

Notwithstanding any general or special law to the contrary, a bona fide group or association of employers may sponsor an association health plan, hereinafter referred to as an AHP, subject to the requirements of this section and regulations of the division of insurance.

An AHP authorized under this section shall meet the following requirements:

(i) the association shall have been formed and maintained in good faith for purposes other than obtaining insurance and shall have a governing structure with bylaws and a constitution;

(ii) the association shall consist of employers or individuals who share a common trade, industry, profession, or geographic region, provided that the commissioner may by regulation expand the allowable size or composition of such associations to improve market stability and access to affordable coverage;

(iii) the association may include sole proprietors and self‑employed individuals as eligible participants;

(iv) the AHP shall purchase a fully insured health benefit plan from a carrier licensed under chapter 175, 176A, 176B, or 176G, unless otherwise permitted by regulation;

(v) the AHP shall comply with all rating, underwriting, and consumer protection requirements applicable to the small group market, unless the commissioner determines that treating the association as a large group would improve affordability and market stability without reducing consumer protections;

(vi) the AHP shall not discriminate against any employer or individual based on health status, medical condition, claims experience, genetic information, disability, or any other factor prohibited under state or federal law;

(vii) the AHP shall file annual reports with the division of insurance, including enrollment, premiums, claims experience, and financial statements, in a form prescribed by the commissioner; and

(viii) the commissioner may promulgate regulations necessary to implement this section, including but not limited to standards for governance, solvency, consumer protections, marketing practices, and oversight."