Texas 2009 - 81st Regular

Texas House Bill HB2881 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R10542 KCR-D
2	2	By: Martinez H.B. No. 2881
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the establishment of the Texas Affordable Health Care
8	8	Benefit Program.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1536 to read as follows:
12	12	CHAPTER 1536. TEXAS AFFORDABLE HEALTH CARE BENEFIT PROGRAM
13	13	SUBCHAPTER A. GENERAL PROVISIONS
14	14	Sec. 1536.001. APPLICABILITY OF CHAPTER. This chapter
15	15	applies only to an entity authorized to issue an individual, group,
16	16	blanket, or franchise insurance policy or insurance agreement, a
17	17	group hospital service contract, or an individual or group evidence
18	18	of coverage or similar coverage document that provides benefits for
19	19	medical or surgical expenses incurred as a result of a health
20	20	condition, accident, or sickness, including:
21	21	(1) an insurance company;
22	22	(2) a group hospital service corporation operating
23	23	under Chapter 842;
24	24	(3) a fraternal benefit society operating under
25	25	Chapter 885;
26	26	(4) a stipulated premium company operating under
27	27	Chapter 884;
28	28	(5) a reciprocal exchange operating under Chapter 942;
29	29	(6) a Lloyd's plan operating under Chapter 941;
30	30	(7) a health maintenance organization operating under
31	31	Chapter 843;
32	32	(8) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846; or
34	34	(9) an approved nonprofit health corporation that
35	35	holds a certificate of authority under Chapter 844.
36	36	Sec. 1536.002. DEFINITIONS. In this chapter:
37	37	(1) "Health benefit plan issuer" means an entity
38	38	described by Section 1536.001.
39	39	(2) "Program" means the Texas Affordable Health Care
40	40	Benefit Program established under Subchapter B.
41	41	Sec. 1536.003. CERTAIN EMPLOYER ACTIONS PROHIBITED. An
42	42	employer in this state that offers health benefit plan coverage to
43	43	employees may not:
44	44	(1) cease to offer health benefit coverage only to
45	45	individuals who are otherwise eligible to purchase health benefit
46	46	plan coverage under the program; or
47	47	(2) require employees who are eligible to purchase
48	48	health benefit plan coverage under the program to purchase that
49	49	coverage.
50	50	Sec. 1536.004. RULES. The commissioner shall adopt rules
51	51	as necessary to implement this chapter.
52	52	[Sections 1536.005-1536.050 reserved for expansion]
53	53	SUBCHAPTER B. PROGRAM ESTABLISHMENT AND REQUIREMENTS
54	54	Sec. 1536.051. PROGRAM ESTABLISHMENT; FUNDING. (a) The
55	55	department shall establish the Texas Affordable Health Care Benefit
56	56	Program to provide affordable health benefit plan coverage in this
57	57	state.
58	58	(b) Each health benefit plan issuer in this state shall
59	59	participate in the program.
60	60	(c) The program is funded through assessments levied by the
61	61	commissioner under Subchapter C.
62	62	Sec. 1536.052. APPLICATION PROCESS. (a) The department
63	63	shall develop a procedure through which individuals and families
64	64	may apply for health benefit plan coverage under the program.
65	65	(b) The application procedure developed under Subsection
66	66	(a) must include:
67	67	(1) an Internet website that provides comparative
68	68	information concerning the premiums for and levels of coverage
69	69	provided under health benefit plans issued under the program; and
70	70	(2) a process through which a hospital or other
71	71	institutional health care provider:
72	72	(A) may assist an individual in applying to
73	73	purchase health benefit plan coverage under the program; and
74	74	(B) at the time of application, receive a
75	75	precertification or preauthorization to treat the patient under the
76	76	terms of the health benefit plan for which the patient has applied.
77	77	Sec. 1536.053. ELIGIBILITY TO PURCHASE COVERAGE. (a)
78	78	Subject to Subsection (b), the following individuals may purchase
79	79	health benefit plan coverage under the program:
80	80	(1) each member of a family with a household annual
81	81	income of $100,000 or less who is not eligible for coverage under a
82	82	health benefit plan issued, sponsored, or paid for by an employer of
83	83	a member of the family and has not been eligible for that coverage
84	84	in the 12 months immediately preceding the date of application for
85	85	coverage issued under the program; and
86	86	(2) an individual other than an individual described
87	87	by Subdivision (1) who has an annual income of $55,000 or less and
88	88	is not eligible for coverage under a health benefit plan issued,
89	89	sponsored, or paid for by an employer and has not been eligible for
90	90	that coverage in the 12 months immediately preceding the date of
91	91	application for coverage issued under the program.
92	92	(b) An individual who is eligible for health benefit
93	93	coverage under Medicaid or a program operated by the United States
94	94	Department of Veterans Affairs may not purchase health benefit plan
95	95	coverage under the program.
96	96	Sec. 1536.054. PREMIUMS. (a) The commissioner by rule
97	97	shall establish a sliding scale for premiums to be charged by health
98	98	benefit plan issuers for health benefit plan coverage under the
99	99	program.
100	100	(b) The sliding scale established under Subsection (a):
101	101	(1) subject to Subdivision (2), must require an
102	102	individual or family to pay not less than $20 per month per person
103	103	and not more than $100 per month per person for health benefit plan
104	104	coverage under the program; and
105	105	(2) must provide a maximum aggregated premium of $400
106	106	per month per family.
107	107	Sec. 1536.055. POLICY PERIOD. The policy period for a
108	108	health benefit plan issued under the program is one year.
109	109	Sec. 1536.056. DEDUCTIBLES AND COPAYMENTS. (a) A health
110	110	benefit plan issued under the program may not have an annual
111	111	deductible that exceeds $1,000.
112	112	(b) A health benefit plan issued under the program may not
113	113	have copayments that exceed $20 per person per visit.
114	114	Sec. 1536.057. REQUIRED COVERAGE. A health benefit plan
115	115	issued under the program must provide coverage:
116	116	(1) for prescription drugs in a manner that complies
117	117	with Chapter 1369; and
118	118	(2) at a level that is equal to or greater than the
119	119	level of coverage provided under a health plan issued under Chapter
120	120	62, Health and Safety Code.
121	121	[Sections 1536.058-1536.100 reserved for expansion]
122	122	SUBCHAPTER C. ASSESSMENTS
123	123	Sec. 1536.101. ANNUAL REPORT TO DEPARTMENT. On September 1
124	124	of each calendar year, a health benefit plan issuer shall report to
125	125	the department:
126	126	(1) the number of individuals covered under a health
127	127	benefit plan issued by the issuer under the program during the
128	128	period beginning on September 1 of the previous calendar year and
129	129	ending on August 31 of the calendar year in which the report is
130	130	made; and
131	131	(2) the gross premiums collected by the health benefit
132	132	plan issuer for health benefit plans issued under the program
133	133	during the period described by Subdivision (1).
134	134	Sec. 1536.102. ASSESSMENT. (a) The commissioner shall
135	135	assess a health benefit plan issuer an amount that is equal to one
136	136	percent of the gross premiums collected by the health benefit plan
137	137	issuer for health benefit plans issued under the program, as
138	138	reported by the health benefit plan issuer under Section
139	139	1536.101(2).
140	140	(b) The commissioner may levy assessments in addition to
141	141	those required under Subsection (a) as necessary to fully fund the
142	142	operation of the program. An assessment levied against a health
143	143	benefit plan issuer under this subsection must be proportional to
144	144	the number of health benefit plans written by the issuer under the
145	145	program to the total number of health benefit plans issued under the
146	146	program.
147	147	(c) A health benefit plan issuer may pay assessments made
148	148	under this section in equal monthly installments or in a lump sum on
149	149	a date determined by the commissioner by rule.
150	150	Sec. 1536.103. USE OF ASSESSMENT. Assessments paid and
151	151	collected under this subchapter may be used only to:
152	152	(1) fund the operation of the program; and
153	153	(2) reimburse health benefit plan issuers for any
154	154	losses incurred as a direct result of participating in the program.
155	155	SECTION 2. The Texas Department of Insurance shall ensure
156	156	that the Texas Affordable Health Care Benefit Program described by
157	157	Chapter 1536, Insurance Code, as added by this Act, is fully
158	158	operational not later than September 1, 2010.
159	159	SECTION 3. This Act takes effect September 1, 2009.