Creates a rule that a qualifying group or association of employers can be treated as the "employer" for employee welfare benefit plans under ERISA, letting multiple small employers and self-employed people offer a single association-run group health plan. It sets eligibility and governance tests for those groups, requires aggregated employee counts, and says offering coverage through the group does not by itself make employers joint employers.

Sets rules for how association plans may set premiums and employer contributions: plans can use a modified community-rating base and adjust employer contributions by each member employer’s risk profile while requiring single pooling and equal premiums where the group is only self-employed individuals. The act also reaffirms that these association plans remain subject to existing federal health law protections (including nondiscrimination and pre-existing condition rules).