S. 2086: Health Marketplace for All Act of 2025

The Health Marketplace for All Act of 2025 is a proposed piece of legislation aimed at modifying the Employee Retirement Income Security Act of 1974 (ERISA) to recognize certain health marketplace pools as "employers." This change allows these pools to offer group health plans and health insurance coverage. Below are the key provisions of the bill:

Definition of Health Marketplace Pools

The bill establishes a definition for health marketplace pools, which are entities formed to provide group health insurance coverage. These pools must:

• Be organized in good faith to create a risk pool for its members.
• Not discriminate against potential members based on health-related factors.

Offering of Insurance Coverage

Health marketplace pools can offer group health plans and insurance coverage that must be made available to all members. The bill stipulates:

• The health plans may include benefits related to prescription drugs, potentially offering these as standalone benefits.
• Coverage must be available to both members and their dependents.
• Plans cannot discriminate in coverage offered among members, although specific underwriting and exclusions as permitted by law may still apply.

Membership and Eligibility

The bill lays out criteria for membership in a health marketplace pool, allowing individuals to enroll in coverage as long as they meet specific eligibility criteria related to their connection with the pool or its members.

• Members can include individuals who directly join the pool, employees of member employers, and dependents of both groups.
• Enrollment procedures and eligibility rules must be applied uniformly and cannot discriminate based on health status.

Regulatory Implications

Participating in a health marketplace pool for the purpose of offering health plans will not create additional employer liabilities or joint employer status under federal or state law outside of the scope of the insurance coverage. This addresses concerns related to liability for employers who participate in these pools.

Geographic Flexibility

The bill does not restrict the establishment of multiple health marketplace pools within the same geographic area, allowing for greater choice and competition.

Administrative Services

Health marketplace pools may provide administrative services to their members, such as billing, accounting, and enrollment assistance.

Drug Coverage Flexibility

Groups offered insurance through these pools may provide both comprehensive drug coverage and the option to offer drug coverage as the only available benefit under their plans.

Conforming Amendments

The legislation also includes technical amendments to align existing laws with the new provisions, ensuring consistency in terms used and clarifying the nature of relationships between member entities and the health plans they offer.

Relevant Companies

None found