Small Business Health Plans Act of 2006 - Directs the Secretary of Health and Human Services (HHS) to establish a small business health benefits program (SBHBP) under which small businesses may offer health insurance coverage to employees and their dependents. Outlines program elements and coverage requirements.
Requires the Secretary to establish a program of premium assistance for small employers under the SBHBP. Allows for reinsurance for catastrophic costs for certain health insurance issuers.
Defines a "small employer" for SBHBP purposes as an employer with 50 or fewer employees.
Directs the Secretary and the Secretary of Labor to provide for the establishment of a national health pooling arrangement for eligible small employers under the SBHBP.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5288 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 5288
To establish a small business health benefits program.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 4, 2006
Mr. Allen (for himself, Mr. Carnahan, Mr. Doggett, Mr. Waxman, Mr.
Brown of Ohio, Ms. Baldwin, Mrs. Capps, and Ms. Schakowsky) introduced
the following bill; which was referred to the Committee on Education
and the Workforce
_______________________________________________________________________
A BILL
To establish a small business health benefits program.
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 ``Small Business Health Plans Act of
2006''.
SEC. 2. SMALL BUSINESS HEALTH BENEFITS PROGRAM (SBHBP).
(a) Establishment.--The Secretary of Health and Human Services
shall establish a small business health benefits program under which
small employers may offer health insurance coverage to employees and
their dependents.
(b) Program Elements.--Under the SBHBP:
(1) Access to insurance.--Small employers are provided
access, for years beginning on or after January 1, 2007, to
qualified health pooling arrangements under which their
employees may elect self-only or family health insurance
coverage under at least 2 health insurance coverage policies,
regardless of whether premium assistance referred to in
paragraph (2) is available with respect to such employer.
(2) Premium assistance for small employers.--Premium
assistance is available under subsection (c) to assist small
employers in the payment of premiums for the health insurance
coverage provided.
(3) Employer share of premiums.--
(A) In general.--Small employers are provided
access to health insurance coverage, and may be
eligible for premium assistance under subsection (c),
only if they pay (before the application of any premium
assistance under subsection (c)) at least 50 percent of
the premiums for coverage of their employees, but such
employers are not required to pay for the portion of
the premiums for dependents of employees.
(B) Construction.--Nothing in this section shall be
construed as preventing an employee from applying the
payment described in subparagraph (A) towards the
payment of premiums for family health insurance
coverage.
(4) Health insurance coverage.--
(A) In general.--Health insurance coverage offered
thereunder shall meet the following requirements:
(i) The Secretary determines that the
coverage is substantially similar to health
benefits coverage in any of the four largest
health benefit plans (determined by enrollment)
offered under chapter 89 of title 5, United
States Code.
(ii) The coverage complies with State laws
and regulations (including applicable benefit
mandates and other consumer protections) for
group health insurance coverage for the State
in which the coverage is offered.
(iii) The coverage does not discriminate,
through underwriting, the imposition of a pre-
existing condition exclusion (as defined in
section 701(b)(1)(A) of the Employee Retirement
Income Security Act of 1974 or section
9801(b)(1)(A) of the Internal Revenue Code of
1986), differential benefits, differential
premiums, or otherwise, against an employee or
dependent on the basis of health status.
(iv) The Secretary determines that the
coverage provided to employees is coordinated,
in accordance with regulations prescribed by
the Secretary, with other coverage provided
under governmental health benefits programs
under which health benefits coverage is
available to such employees.
(B) Standards for participating health insurers.--
In administering the program, the Secretary shall
promote participation by health insurers that
establish--
(i) integration of health information
technology tools to promote quality;
(ii) chronic disease management;
(iii) preventive health care services; and
(iv) evidence-based medicine considerations
of prescription drugs and other treatment that
take into account the individual medical
circumstances of individuals enrolled in the
program.
(5) Enrollment.--In administering the program, the
Secretary shall provide that employee enrollment (and changes
in enrollment) are limited to an annual open enrollment period,
except in the case of qualifying events (such as change in
family status) specified by the Secretary and consistent with
section 701(f) of the Employee Retirement Income Security Act
of 1974 (29 U.S.C. 1181(f)).
(c) Premium Assistance.--Under the SBHBP, the Secretary shall
establish a program of premium assistance for small employers. Such
program shall provide for a sliding scale of assistance to such
employers taking into account the following:
(1) The number of employees of the employer.
(2) The average wage level of such employees relative to
the average wage level for employees in the same geographic
area.
(3) The profit margin of the employer.
(d) Reinsurance for Catastrophic Costs for Certain Health Insurance
Issuers.--
(1) In general.--In the case of health insurance coverage
offered under the SBHBP by a health insurance issuer that
participates in a qualified health pooling arrangement, the
Secretary shall provide for reinsurance coverage for 75 percent
of covered claims that exceed, for an individual for a year, an
amount determined by the Secretary for such year which is not
less than the minimum amount specified in paragraph (2).
(2) Minimum amount.--The minimum amount specified in this
paragraph is--
(A) for the first year in which this section is in
effect, $100,000; or
(B) for a subsequent year is the minimum amount
specified in this paragraph for a previous year,
increased by the Secretary's estimate of the average
annual percentage increase in health insurance coverage
with a median level of premiums for the previous year.
Any amount determined under subparagraph (B) which is not a
multiple of $1,000 shall be rounded to the nearest multiple of
$1,000.
(e) Qualified Health Pooling Arrangement.--For purposes of this
section, the term ``qualified health pooling arrangement'' means, with
respect to employees employed in any State for any year--
(1) except as provided in subparagraph (B), an arrangement
established by (and operating under the oversight of) such
State for purposes of this section, in accordance with
regulations of the Secretary, which provides for pooling of
health insurance coverage offered for such year in such State,
and
(2) in any case in which there is not in effect for any
year an arrangement described in subparagraph (A) established
by such State, the national health pooling arrangement
established under section 3.
The Secretary shall determine, within a reasonable time prior to each
year, whether there is a qualified health pooling arrangement described
in paragraph (1) with respect to employees employed in any State.
(f) Small Employer Defined.--
(1) In general.--For purposes of this Act, except as
otherwise provided in this subsection, the term ``small
employer'' means an employer with 50 or fewer employees, as
determined under regulations promulgated by the Secretary.
(2) Continuation of participation.--An employer whose
employees are provided health insurance coverage under the
SBHBP while the employer is a small employer as defined in
paragraph (1) and who thereafter has more than 50 employees
shall continue to be treated as a small employer.
(3) Employers not in existence in preceding year.--In the
case of an employer which was not in existence for the full
year prior to the date on which the employer applies to
participate in SBHBP, the determination of whether such
employer meets the requirements of paragraph (1) shall be based
on the average number of employees that it is reasonably
expected such employer will employ on business days in the
employer's first full year.
(4) Waiver.--The Secretary may waive the limitations
relating to the size of an employer which may participate under
SBHBP on a case by case basis if the Secretary determines that
such employer makes a compelling case for such a waiver. In
making determinations under this paragraph, the Secretary shall
consider the effects of the employment of temporary and
seasonal workers and other related factors.
(g) Other Definitions.--For purposes of this Act:
(1) The terms ``employee'' and ``dependent'' have the
meanings given such terms by the Secretary in regulations and
shall be based upon the definitions of such terms used for
purposes of the Federal employee health benefits program
established under chapter 89 of title 5, United States Code.
(2) The terms ``health insurance coverage'' and ``health
insurance issuer'' have the meanings given such terms in
section 2791(b) of the Public Health Service Act (42 U.S.C.
300gg-91(b)).
(3) The term ``Secretary'' means the Secretary of Health
and Human Services.
(4) The term ``SBHBP'' means the small business health
benefits program established under this section.
(5) The term ``State'' has the meaning given such term in
section 2791(d)(14) of the Public Health Service Act (42 U.S.C.
300gg-91(d)(14)).
(h) Grants for Establishment of State Qualified Health Pooling
Arrangements.--
(1) In general.--The Secretary shall provide grants to
States for the establishment and initial administration of
qualified health pooling arrangements described in subsection
(e)(1).
(2) Authorization of appropriations.--There are authorized
to be appropriated such sums as may be necessary to carry out
this subsection.
SEC. 3. ESTABLISHMENT OF NATIONAL HEALTH POOLING ARRANGEMENT.
(a) In General.--The Secretary of Health and Human Services and the
Secretary of Labor, acting jointly and in consultation with the
Director of the Office of Personnel Management, shall provide for--
(1) the offering on a timely basis consistent with section
2 of a national health pooling arrangement to eligible small
employers; and
(2) appropriate oversight over any such arrangement.
(b) Specific Requirements.--In carrying out subsection (a), the
Secretaries shall--
(1) model the national health pooling arrangement on the
Federal employees health benefits program under chapter 89 of
title 5, United States Code, to the extent practicable and
consistent with the other requirements of this Act; and
(2) consistent with paragraph (1), negotiate the most
affordable and substantial coverage possible for small
employers.
(c) Definitions.--For purposes of this section--
(1) the term ``Secretaries'' means the Secretary of Health
and Human Services and the Secretary of Labor; and
(2) the term ``national health pooling arrangement'' means
an arrangement which provides for pooling of health insurance
coverage offered for any year in all States which do not have
in effect for such year an arrangement for pooling of health
insurance coverage offered in such States.
<all>
Introduced in House
Introduced in House
Referred to the House Committee on Education and the Workforce.
Referred to the Subcommittee on Employer-Employee Relations.
Sponsor introductory remarks on measure. (CR H3487-3488)
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