HB 464 – Small Business Health Care Act

Primary Sponsors: Rep. Kyle Hall (R-Stokes), Rep. Holly Grange (R-New Hanover), Rep. Josh Dobson (R-Avery), Rep. Brian Turner (D-Buncombe)

Bill Summary

Association Requirements

  • Be an employer within the definition of the Employee Retirement Income Security Act of 1974.
  • Provide regular meetings
  • Collect dues
  • Operation by a board of trustees that consists of an owner, partner, officer, director or employee
  •  Have at least one substantial business purpose unrelated to the offering of providing health insurance
  • Have a registered multiple employer welfare arrangement with the Commissioner
  • Have a commonality of interest

Membership Requirements

  • In order to obtain coverage of the association health plan, an employer member must be a member of the sponsoring association
  • Employers would only be able to cover individuals who are paid on an IRS Form 1099
  • In order to obtain coverage employer members must commit to remaining members of the sponsoring association and receive payments and benefits under the association health plan for a period of at least two years.

Health Plan Requirements

  • May not be offered or advertised the the public generally
  • Provide coverage equal to or greater than 60% of actuarial value of allowed costs for covered benefits
  • Provide coverage for hospital and physician services
  • Comply with Chapter 58 patient and provider protections

Solvency Requirements for Association

  • Established and maintained in good faith for a period of at least 5 years
  • Minimum of 500 persons eligible to receive coverage through the association health plan
  • Enforce provisions that are intended to prevent or deter employer members from terminating coverage


  • Eligibility for coverage by the plan can not include any of the following health status factors.


  • The plan shall not require any individual to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the plan on the basis of any health related factor.

Bill Movement

This bill was filed on March 26, 2019.

This bill was referred to the following House Committees:

  • Insurance – passed on April 11, 2019
    • A proposed committee substitute was introduced on April 11, 2019
    • Rep. Hall introduced an amendment to ensure that current MEWAs were not impacted.
      • The amendment passed
    • Rep. Holley introduced an amendment to include essential health benefits.
      • The amendment passed
  • Health
  • Rules