Employer Health Plan Flexibility Act
Sponsored By: Representative Allen, Rick W. [R-GA-12]
Introduced
Summary
Exempts employer-sponsored ERISA group health plans from the Affordable Care Act's Essential Health Benefits requirement.
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It would also require annual participant notices about which benefits are covered and direct the Department of Health and Human Services to update regulations to reflect the exemption.
- Workers and families: Plans governed by ERISA could omit some Essential Health Benefits, so enrollees must check yearly notices that list excluded benefits and explain cost sharing.
- Employers: Would gain flexibility to design ERISA group health plans without meeting ACA Essential Health Benefits rules. The change would apply to plan years beginning on or after January 1, 2028.
- Federal rules and regulators: The Secretary of Health and Human Services must revise regulations, while existing federal protections such as HIPAA portability, nondiscrimination rules, the Mental Health Parity and Addiction Equity Act, COBRA, ERISA fiduciary duties, and applicable Internal Revenue Code requirements remain in place.
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Bill Overview
Analyzed Economic Effects
2 provisions identified: 0 benefits, 0 costs, 2 mixed.
Employers could drop ACA benefits
If enacted, employer-sponsored group health plans governed by ERISA would not have to provide the ACA's Essential Health Benefits. The Secretary of Health and Human Services would revise regulations to reflect the exemption. The change would apply to plan years beginning on or after January 1, 2028. If your employer's plan claims the exemption, the plan would have to give you a yearly notice. The notice would list covered benefits, which ACA benefits are not covered, cost sharing, and how to get the Summary Plan Description. The bill would keep other federal protections in place, such as HIPAA portability and nondiscrimination rules, mental health parity rules, COBRA continuation coverage, ERISA fiduciary duties, tax rules that apply to employer plans, federal nondiscrimination rules, and preventive services requirements unless another law says otherwise.
Employers may still offer ACA benefits
If enacted, the bill would say nothing in it prohibits an employer from voluntarily providing some or all ACA Essential Health Benefits. The bill would also say it does not alter ERISA preemption or change state regulation of health insurance issuers except where the bill expressly provides. These clarifications would apply to plan years beginning on or after January 1, 2028.
Sponsors & CoSponsors
Sponsor
Allen, Rick W. [R-GA-12]
GA • R
Cosponsors
There are no cosponsors for this bill.
Roll Call Votes
No roll call votes available for this bill.
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