81R10542 KCR-D
By: Martinez H.B. No. 2881
A BILL TO BE ENTITLED
AN ACT
relating to the establishment of the Texas Affordable Health Care
Benefit Program.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
by adding Chapter 1536 to read as follows:
CHAPTER 1536. TEXAS AFFORDABLE HEALTH CARE BENEFIT PROGRAM
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1536.001. APPLICABILITY OF CHAPTER. This chapter
applies only to an entity authorized to issue an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, or an individual or group evidence
of coverage or similar coverage document that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a Lloyd's plan operating under Chapter 941;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
Sec. 1536.002. DEFINITIONS. In this chapter:
(1) "Health benefit plan issuer" means an entity
described by Section 1536.001.
(2) "Program" means the Texas Affordable Health Care
Benefit Program established under Subchapter B.
Sec. 1536.003. CERTAIN EMPLOYER ACTIONS PROHIBITED. An
employer in this state that offers health benefit plan coverage to
employees may not:
(1) cease to offer health benefit coverage only to
individuals who are otherwise eligible to purchase health benefit
plan coverage under the program; or
(2) require employees who are eligible to purchase
health benefit plan coverage under the program to purchase that
coverage.
Sec. 1536.004. RULES. The commissioner shall adopt rules
as necessary to implement this chapter.
[Sections 1536.005-1536.050 reserved for expansion]
SUBCHAPTER B. PROGRAM ESTABLISHMENT AND REQUIREMENTS
Sec. 1536.051. PROGRAM ESTABLISHMENT; FUNDING. (a) The
department shall establish the Texas Affordable Health Care Benefit
Program to provide affordable health benefit plan coverage in this
state.
(b) Each health benefit plan issuer in this state shall
participate in the program.
(c) The program is funded through assessments levied by the
commissioner under Subchapter C.
Sec. 1536.052. APPLICATION PROCESS. (a) The department
shall develop a procedure through which individuals and families
may apply for health benefit plan coverage under the program.
(b) The application procedure developed under Subsection
(a) must include:
(1) an Internet website that provides comparative
information concerning the premiums for and levels of coverage
provided under health benefit plans issued under the program; and
(2) a process through which a hospital or other
institutional health care provider:
(A) may assist an individual in applying to
purchase health benefit plan coverage under the program; and
(B) at the time of application, receive a
precertification or preauthorization to treat the patient under the
terms of the health benefit plan for which the patient has applied.
Sec. 1536.053. ELIGIBILITY TO PURCHASE COVERAGE. (a)
Subject to Subsection (b), the following individuals may purchase
health benefit plan coverage under the program:
(1) each member of a family with a household annual
income of $100,000 or less who is not eligible for coverage under a
health benefit plan issued, sponsored, or paid for by an employer of
a member of the family and has not been eligible for that coverage
in the 12 months immediately preceding the date of application for
coverage issued under the program; and
(2) an individual other than an individual described
by Subdivision (1) who has an annual income of $55,000 or less and
is not eligible for coverage under a health benefit plan issued,
sponsored, or paid for by an employer and has not been eligible for
that coverage in the 12 months immediately preceding the date of
application for coverage issued under the program.
(b) An individual who is eligible for health benefit
coverage under Medicaid or a program operated by the United States
Department of Veterans Affairs may not purchase health benefit plan
coverage under the program.
Sec. 1536.054. PREMIUMS. (a) The commissioner by rule
shall establish a sliding scale for premiums to be charged by health
benefit plan issuers for health benefit plan coverage under the
program.
(b) The sliding scale established under Subsection (a):
(1) subject to Subdivision (2), must require an
individual or family to pay not less than $20 per month per person
and not more than $100 per month per person for health benefit plan
coverage under the program; and
(2) must provide a maximum aggregated premium of $400
per month per family.
Sec. 1536.055. POLICY PERIOD. The policy period for a
health benefit plan issued under the program is one year.
Sec. 1536.056. DEDUCTIBLES AND COPAYMENTS. (a) A health
benefit plan issued under the program may not have an annual
deductible that exceeds $1,000.
(b) A health benefit plan issued under the program may not
have copayments that exceed $20 per person per visit.
Sec. 1536.057. REQUIRED COVERAGE. A health benefit plan
issued under the program must provide coverage:
(1) for prescription drugs in a manner that complies
with Chapter 1369; and
(2) at a level that is equal to or greater than the
level of coverage provided under a health plan issued under Chapter
62, Health and Safety Code.
[Sections 1536.058-1536.100 reserved for expansion]
SUBCHAPTER C. ASSESSMENTS
Sec. 1536.101. ANNUAL REPORT TO DEPARTMENT. On September 1
of each calendar year, a health benefit plan issuer shall report to
the department:
(1) the number of individuals covered under a health
benefit plan issued by the issuer under the program during the
period beginning on September 1 of the previous calendar year and
ending on August 31 of the calendar year in which the report is
made; and
(2) the gross premiums collected by the health benefit
plan issuer for health benefit plans issued under the program
during the period described by Subdivision (1).
Sec. 1536.102. ASSESSMENT. (a) The commissioner shall
assess a health benefit plan issuer an amount that is equal to one
percent of the gross premiums collected by the health benefit plan
issuer for health benefit plans issued under the program, as
reported by the health benefit plan issuer under Section
1536.101(2).
(b) The commissioner may levy assessments in addition to
those required under Subsection (a) as necessary to fully fund the
operation of the program. An assessment levied against a health
benefit plan issuer under this subsection must be proportional to
the number of health benefit plans written by the issuer under the
program to the total number of health benefit plans issued under the
program.
(c) A health benefit plan issuer may pay assessments made
under this section in equal monthly installments or in a lump sum on
a date determined by the commissioner by rule.
Sec. 1536.103. USE OF ASSESSMENT. Assessments paid and
collected under this subchapter may be used only to:
(1) fund the operation of the program; and
(2) reimburse health benefit plan issuers for any
losses incurred as a direct result of participating in the program.
SECTION 2. The Texas Department of Insurance shall ensure
that the Texas Affordable Health Care Benefit Program described by
Chapter 1536, Insurance Code, as added by this Act, is fully
operational not later than September 1, 2010.
SECTION 3. This Act takes effect September 1, 2009.