Texas 2009 - 81st Regular

Texas Senate Bill SB842 Compare Versions

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1	1	81R27252 PMO-D
2	2	By: Averitt S.B. No. 842
3	3	Substitute the following for S.B. No. 842:
4	4	By: Smithee C.S.S.B. No. 842
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the operation of health care sharing organizations.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Participants of a health care sharing
12	12	organization voluntarily assist fellow participants with the
13	13	payment of medical expenses. In many instances, participants of a
14	14	health care sharing organization provide assistance to individuals
15	15	who are without health insurance coverage and, in doing so, provide
16	16	important services that the state would otherwise have to provide.
17	17	Due to their beneficial work and religious nature, health care
18	18	sharing organizations should be statutorily recognized as
19	19	religious organizations helping to fulfill the religious beliefs of
20	20	organization participants and should not be treated in the same
21	21	manner as secular health care coverages, including insurance.
22	22	SECTION 2. Title 8, Insurance Code, is amended by adding
23	23	Subtitle K to read as follows:
24	24	SUBTITLE K. NONINSURANCE HEALTH COVERAGES
25	25	CHAPTER 1680. HEALTH CARE SHARING ORGANIZATIONS
26	26	Sec. 1680.001. SHORT TITLE. This chapter may be cited as
27	27	the Health Care Sharing Organizations Freedom to Share Act.
28	28	Sec. 1680.002. TREATMENT AS HEALTH CARE SHARING
29	29	ORGANIZATION. An organization that administers a health care
30	30	sharing arrangement among individuals of the same religion based on
31	31	the individuals' sincerely held religious belief qualifies for
32	32	treatment as a health care sharing organization under this chapter
33	33	if:
34	34	(1) the organization is a bona fide religious
35	35	organization, the primary purpose and function of which is
36	36	religious, that is entitled to tax exempt status under Section
37	37	501(c)(3) Internal Revenue Code of 1986; and
38	38	(2) in operating the health care sharing arrangement,
39	39	the organization:
40	40	(A) does not bear risk but facilitates payments
41	41	to participants who have financial or medical-related needs from
42	42	participants with the present ability to assist those with
43	43	financial or medical-related needs, all in accordance with the
44	44	organization's criteria;
45	45	(B) notifies a participant of sharing amounts;
46	46	(C) provides a written monthly statement to all
47	47	participants listing the total dollar amount of qualified needs
48	48	submitted to the organization as well as the total dollar amount
49	49	actually assigned to participants for sharing;
50	50	(D) maintains a complaint log to track complaints
51	51	by participants and retains information regarding each complaint
52	52	until the third anniversary of the date the complaint is made;
53	53	(E) provides, on each application for
54	54	participation in a health care sharing arrangement distributed
55	55	directly or on behalf of the organization, a notice that complies
56	56	with Section 1680.003; and
57	57	(F) requires each adult member to sign on behalf
58	58	of the participant or, in the case of a minor or dependent child, on
59	59	behalf of the minor or dependent child an acknowledgment that the
60	60	member has read and understands the notice described by Section
61	61	1680.003 and retains the signed acknowledgment until the second
62	62	anniversary of the last date of the member's participation in the
63	63	health care sharing arrangement.
64	64	Sec. 1680.003. NOTICE. The notice described by Section
65	65	1680.002(2)(E) must be printed in no smaller than 12-point font and
66	66	must read substantially as follows:
67	67	"This health care sharing organization is not offering an
68	68	insurance product, and the health care sharing arrangement is not
69	69	being offered by or through an insurance company. Participation in
70	70	the health care sharing organization may limit your future options
71	71	to purchase insurance if your health condition changes.
72	72	Participation in the health care sharing organization does not
73	73	provide creditable coverage, and, therefore, future insurance
74	74	coverage you obtain may limit or exclude benefits for your
75	75	preexisting conditions.
76	76	"This health care sharing organization is also not offering a
77	77	discount health care program.
78	78	"Whether anyone chooses to assist you with your medical bills
79	79	is voluntary, as no other participant may be compelled to share
80	80	payment of your medical bills.
81	81	"This health care sharing arrangement is not insurance or a
82	82	substitute for insurance. Whether you receive any payments for
83	83	medical expenses and whether this health care sharing organization
84	84	or arrangement continues to operate, you remain, to the extent
85	85	allowable under law, personally and fully responsible for the
86	86	payment of your own medical bills. Complaints concerning this
87	87	health care sharing organization may be reported to the Texas
88	88	Office of the Attorney General."
89	89	Sec. 1680.004. AUTHORITY; LIMITATIONS. (a) A health care
90	90	sharing organization may:
91	91	(1) establish additional qualifications for
92	92	participation in the health care sharing arrangement;
93	93	(2) limit the financial or medical-related needs that
94	94	may be eligible for payment among the participants;
95	95	(3) cancel a participant's participation in the health
96	96	care sharing arrangement if the participant fails to make a
97	97	specific payment to another participant before the 60th day after
98	98	the date the payment is due; and
99	99	(4) issue participant membership cards.
100	100	(b) If a health care sharing organization issues
101	101	participant membership cards, the cards must include the statement
102	102	"Not Insurance."
103	103	(c) A health care sharing organization may not require that
104	104	participants speak English.
105	105	Sec. 1680.005. CONSTRUCTION WITH OTHER LAW. (a) Chapter
106	106	76, Health and Safety Code, does not apply to a health care sharing
107	107	organization.
108	108	(b) Notwithstanding any other provision of this code, a
109	109	health care sharing organization is exempt from the operation of
110	110	the insurance laws of this state and is not subject to the
111	111	commissioner's oversight.
112	112	Sec. 1680.006. ENFORCEMENT AND ADMINISTRATION BY ATTORNEY
113	113	GENERAL. (a) Notwithstanding any other law, the office of the
114	114	attorney general has jurisdiction over health care sharing
115	115	organizations to ensure compliance with this chapter and for:
116	116	(1) the prevention and prosecution of deceptive trade
117	117	practices and fraud; and
118	118	(2) consumer protection.
119	119	(b) A health care sharing organization shall provide to the
120	120	attorney general, on the request of the attorney general, any audit
121	121	conducted of the organization and any original or amended annual
122	122	filing made by the organization with the United States Internal
123	123	Revenue Service.
124	124	(c) The attorney general may adopt rules to implement this
125	125	chapter.
126	126	Sec. 1680.007. CONSUMER PROTECTION. A participant in a
127	127	health care sharing organization is a consumer for purposes of
128	128	Section 17.46(a), Business & Commerce Code, and is entitled to the
129	129	protections of the office of the attorney general as provided by
130	130	that section.
131	131	Sec. 1680.008. NO ASSUMPTION OF RISK. (a) Participants in
132	132	a health care sharing arrangement and the health care sharing
133	133	organization:
134	134	(1) do not assume any risk or make any promise to pay
135	135	the financial or medical-related needs of other participants; and
136	136	(2) are not risk-bearing entities.
137	137	(b) None of the activities in this chapter give rise to an
138	138	assumption of risk or promise to pay by either the participants or
139	139	the health care sharing organization.
140	140	Sec. 1680.009. COLLATERAL SHARING ACTIVITIES. A health
141	141	care sharing organization may:
142	142	(1) arrange for participants to share bills when a
143	143	participant experiences disability; and
144	144	(2) provide health counseling, education, and
145	145	resources to participants in the health care sharing arrangement.
146	146	Sec. 1680.010. CONTRACTUAL ARRANGEMENTS WITH OTHER
147	147	ENTITIES. (a) A health care sharing organization may contract
148	148	with an administrator as defined by Chapter 4151, Insurance Code,
149	149	or a preferred provider organization or similar entity to
150	150	facilitate the operation of the organization.
151	151	(b) A health care sharing organization that enters into a
152	152	contractual arrangement under Subsection (a) remains exempt from
153	153	the operation of the insurance laws of this state as described by
154	154	Section 1680.005.
155	155	Sec. 1680.011. ANNUAL REPORT. Not later than January 1 of
156	156	each year, the organization shall file an annual report regarding
157	157	its operations in this state during that fiscal year with the
158	158	governor, attorney general, lieutenant governor, and speaker of the
159	159	house of representatives.
160	160	SECTION 3. Subsection (a), Section 101.055, Insurance Code,
161	161	is amended to read as follows:
162	162	(a) Section 101.051(b)(7) does not apply to:
163	163	(1) a program otherwise authorized by law that is
164	164	established:
165	165	(A) by a political subdivision of this state;
166	166	(B) by a state agency; or
167	167	(C) under Chapter 791, Government Code; [or]
168	168	(2) a multiple employer welfare arrangement that is
169	169	fully insured as defined by 29 U.S.C. Section 1144(b)(6); or
170	170	(3) a health care sharing organization operated under
171	171	Chapter 1680.
172	172	SECTION 4. Section 76.002, Health and Safety Code, is
173	173	amended to read as follows:
174	174	Sec. 76.002. CONSTRUCTION WITH [APPLICABILITY OF] OTHER
175	175	LAW. (a) In addition to the requirements of this chapter, a
176	176	program operator or marketer is subject to the applicable consumer
177	177	protection laws under Chapter 17, Business & Commerce Code.
178	178	(b) This chapter does not apply to a health care sharing
179	179	organization operated under Chapter 1680, Insurance Code.
180	180	SECTION 5. This Act takes effect immediately if it receives
181	181	a vote of two-thirds of all the members elected to each house, as
182	182	provided by Section 39, Article III, Texas Constitution. If this
183	183	Act does not receive the vote necessary for immediate effect, this
184	184	Act takes effect September 1, 2009.