S. 2086 — Health Marketplace for All Act of 2025

This section amends the definition of "employer" under ERISA (29 U.S.C. 1002(5)) to deem qualifying health marketplace pools as employers solely for purposes of offering group health plans or group health insurance coverage, including such plans or coverage offering prescription or nonprescription drugs (including over-the-counter drugs) as the only benefit; and adds a new ERISA section 736 specifying requirements for such pools. Those requirements are that the pool (1) be organized in good faith as a risk pool without conditioning membership on health status-related factors; (2) offer coverage to all members (and their employees and dependents) on a nondiscriminatory basis at set rates, via self-insurance or issuer contract; (3) operate without geographic limits on multiple pools; (4) provide optional administrative services; and (5) allow drug-only coverage. (Thus, these pools—formed by entities, their members, employees, or dependents—may offer ERISA-regulated group health arrangements with ACA group market protections such as guaranteed issue and no preexisting condition exclusions.)

This section makes conforming amendments to three definitions in ERISA Section 3 (29 U.S.C. 1002) for health marketplace pools meeting the requirements of section 736(b), which offer group health plans or coverage (including plans or coverage covering prescription or nonprescription drugs as the only benefit): (1) revises the definition of "employee" to include any member of such a pool; (2) revises the definition of "fiduciary" to specify that membership in such a pool does not by itself cause a person to be a fiduciary with respect to the group health plan or coverage offered by the pool; and (3) expands the definition of "group health plan" to include any such plan or coverage offered by the pool.