Employer Group Purchasing Reform Act of 1995

TABLE OF CONTENTS:

Title I: Employee Group Health Plan Security

Title II: Multiple Employer Welfare Arrangement Reform

Title III: Health Plan Purchasing Coalitions

Employer Group Purchasing Reform Act of 1995 - Amends the Employee Retirement Income Security Act of 1974 (ERISA) to revise provisions relating to protection for employees in self-funded employee benefit health plans, State regulation of multiple employer welfare arrangement (MEWA) operators, and voluntary health plan purchasing coalitions.

(Sec. 2) Revises ERISA definitions and special rules to refer to self-funded, as well as to fully insured, employee benefit group health plans. Defines a self-funded health plan so as to require employers or plan sponsors to retain substantial financial risk for providing benefits under the plan as provided by regulations promulgated by the Secretary of Labor (in order for such plans to be afforded ERISA preemption from State insurance laws).

Title I: Employee Group Health Plan Security - Establishes employee benefit group health plan nondiscrimination requirements under ERISA. Prohibits specified discrimination practices. Limits waiting periods based on preexisting conditions. Requires credit for qualifying previous coverage. Prohibits catastrophic or lifetime limits on coverage.

(Sec. 102) Establishes disclosure requirements. Revises plan notification, disclosure, and termination requirements for fully insured or self-insured health plans. Provides increased security of health benefits for employees enrolled in employer-sponsored plans.

(Sec. 103) Requires plan sponsors to notify each participant of the termination of a health plan, whether fully insured or self-funded, at least 90 days prior to the termination. Prohibits employers from modifying benefit or contribution levels in that 90-day period before termination.

Requires self-funded health plans to submit proof of purchase of an involuntary termination policy, which must provide participants 90 days of coverage beyond the plan's termination date, with exceptions for single-employer plans with a AAA bond credit rating and for multiemployer plans that meet specified requirements under the Labor Management Relations Act of 1947.

Title II: Multiple Employer Welfare Arrangement Reform - Revises ERISA definitions with respect to the status of plans managed by participating employers under multiple employer welfare arrangements (MEWAs). Provides that even if a MEWA is not treated as a benefit plan for ERISA purposes, each employer participating in a MEWA will be treated as maintaining (through the MEWA) a benefit plan, and the employer's employees will be treated as the plan's participants.

(Sec. 201) Revises the definition of MEWA to include certain employee leasing arrangements. Requires MEWAs to register annually with the Department of Labor.

Revises the definition of common control for single employer arrangements.

(Sec. 202) Modifies preemption rules for MEWAs. Provides that State insurance laws apply to any MEWA which is an employee group health plan.

(Sec. 203) Sets forth criminal penalties for false representation of the MEWA to any employer, employee, beneficiary, State, or the Secretary.

Title III: Health Plan Purchasing Coalitions - Establishes provisions for health plan purchasing coalitions, which may be formed by groups of individuals or employers, but not formed or underwritten by insurers, agents, brokers, or any other individual or entity engaged in the sale of insurance.

(Sec. 301) Requires State certification and Federal registration of such purchasing coalitions. Considers a purchasing coalition to be domiciled in the State in which most of its members are located. Requires each purchasing coalition to be governed by a board of directors, with certain requirements for board composition. Permits purchasing coalitions to establish membership criteria. Authorizes States to establish rules regarding the geographic area served by a purchasing coalition.

Requires a purchasing coalition to: (1) enter into agreements with insured health plans; (2) enter into agreements with members; (3) participate in State-established risk adjustment or reinsurance programs; (4) prepare and distribute materials to permit members to compare plans; (5) market within the service area; and (6) act as ombudsman for all enrollees. Prohibits the purchasing coalition from performing certain other activities, including licensing health plans and assuming financial risk.

Provides that members of the purchasing coalition (employers or plans) will be treated as maintaining a benefit plan on behalf of plan participants. Allows a purchasing coalition to act as plan administrator for employer members.

Preempts State fictitious group laws, certain State rating requirement laws, and certain State mandated benefit laws.

(Sec. 302) Permits the States to apply to the Secretary for partial or complete authority to enforce certain ERISA provisions relating to MEWAs and health plan purchasing coalitions. Authorizes the Secretary to provide assistance to the States by: (1) establishing communications between the Pension and Welfare Benefits Administration and State agencies to share information on specific cases; (2) providing technical assistance relating to regulation of MEWAs; (3) assisting States in getting advisory opinions; and (4) distributing advisory opinions to State insurance commissioners.