82R3090 KCR-F
By: Laubenberg H.B. No. 1362
A BILL TO BE ENTITLED
AN ACT
relating to the creation of a voluntary consumer-directed health
plan for certain individuals eligible to participate in the
insurance coverage provided under the Texas Employees Group
Benefits Act and their qualified dependents.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1551, Insurance Code, is amended by
adding Subchapter J to read as follows:
SUBCHAPTER J. STATE CONSUMER-DIRECTED HEALTH PLAN
Sec. 1551.451. DEFINITIONS. In this subchapter:
(1) "High deductible health plan" means a health
benefit plan that complies with Section 223(c), Internal Revenue
Code of 1986, and other federal law.
(2) "Plan enrollee" means a participant who is
enrolled in the plan established under this subchapter.
(3) "Qualified medical expense" means an expense paid
by a plan enrollee for medical care, as defined by Section 213(d),
Internal Revenue Code of 1986, for the enrollee or the enrollee's
dependents as defined by Section 152, Internal Revenue Code of
1986.
Sec. 1551.452. ESTABLISHMENT OF STATE CONSUMER-DIRECTED
HEALTH PLAN. (a) The state consumer-directed health plan is
established for the benefit of individuals eligible to participate
in the group benefits program and those individuals' eligible
dependents.
(b) After the board of trustees adopts rules necessary to
administer this subchapter, the board shall:
(1) establish health savings accounts under this
subchapter and administer or select an administrator for the
accounts;
(2) finance or purchase a high deductible health plan
that:
(A) is an integral part of the state
consumer-directed health plan; and
(B) provides health benefit coverage, including
preventive health care, to a plan enrollee in the state
consumer-directed health plan and to the dependents of a plan
enrollee in accordance with Section 1551.456; and
(3) provide to individuals eligible to participate in
the group benefits program information regarding the option to
participate in and operation of the state consumer-directed health
plan established under this subchapter.
(c) If the board of trustees purchases a high deductible
health plan under this subchapter, Sections 1551.215-1551.218
apply to the high deductible health plan.
(d) In adopting rules and administering health savings
accounts or selecting administrators for health savings accounts
under this subchapter, the board of trustees shall ensure that the
health savings accounts are qualified for appropriate federal tax
exemptions.
Sec. 1551.453. PARTICIPATION IN STATE CONSUMER-DIRECTED
HEALTH PLAN; EFFECT OF PARTICIPATION. (a) The board of trustees
shall offer individuals eligible to participate in the basic
coverage plan the option of waiving participation in the basic
coverage plan and instead electing participation in the state
consumer-directed health plan.
(b) For purposes of this chapter, participation in the state
consumer-directed health plan is considered participation in the
group benefits program, and Sections 1551.301, 1551.303, 1551.305,
and 1551.306 apply to participation in the state consumer-directed
health plan in the same manner that those sections apply to the
basic coverage plan.
Sec. 1551.454. ACCOUNT ADMINISTRATOR. (a) The account
administrator selected to administer a health savings account
established under this subchapter must be a person:
(1) qualified to serve as trustee under Section
223(d)(1)(B), Internal Revenue Code of 1986, and the rules adopted
under that section; and
(2) experienced in administering health savings
accounts or other similar trust accounts.
(b) An account administrator is the fiduciary of a plan
enrollee who has a health savings account established under this
subchapter.
(c) Section 1551.056(b) does not apply to the account
administrator.
Sec. 1551.455. PARTICIPATION IN PROGRAM. (a) Each
individual eligible to participate in the basic coverage may choose
instead to participate in the state consumer-directed health plan
if the plan enrollee is an eligible individual under Section
223(c)(1), Internal Revenue Code of 1986. The dependents of a plan
enrollee may participate in the state consumer-directed health plan
in accordance with Section 1551.456.
(b) A plan enrollee waives basic plan coverage and must be
enrolled in a high deductible health plan.
(c) Participation in the state consumer-directed health
plan qualifies a plan enrollee to receive a contribution to a health
savings account under Section 1551.458. An individual who elects
not to participate in the plan is not eligible to receive a
contribution under that section.
(d) A plan enrollee is subject to Subchapter H in the same
manner as an individual who participates in the basic coverage
offered under the group benefits program.
(e) Under this section, the board of trustees has exclusive
authority to determine an individual's eligibility to participate
in the state consumer-directed health plan and shall adopt rules
regarding eligibility to participate in the plan.
Sec. 1551.456. COVERAGE FOR DEPENDENTS; REQUIRED
CONTRIBUTIONS. (a) Subject to Subsection (d), a plan enrollee is
entitled to obtain for the enrollee's dependents coverage in the
state consumer-directed health plan in the manner determined by the
board of trustees.
(b) The plan enrollee shall make any required additional
contribution payments for the dependent coverage in the manner
prescribed by the board of trustees.
(c) Amounts contributed by a plan enrollee under this
section may be:
(1) used to pay the cost of coverage in the state
consumer-directed health plan not paid by the state under Section
1551.458(b)(1); or
(2) contributed as additional amounts to the health
savings account provided to the enrollee.
(d) A covered dependent of a plan enrollee:
(1) is subject to Subchapter H in the same manner as a
dependent who is covered by the basic coverage offered under the
group benefits program; and
(2) must be a dependent for purposes of:
(A) Section 152, Internal Revenue Code of 1986;
and
(B) Section 1551.004.
Sec. 1551.457. IDENTIFICATION CARDS FOR PLAN ENROLLEES.
(a) The board of trustees or the account administrator, as
applicable, shall issue to each plan enrollee an identification
card.
(b) The board of trustees or the account administrator, as
applicable, shall issue a duplicate identification card to each
plan enrollee's dependent for whom qualified medical expenses may
be paid out of a health savings account established under this
subchapter.
Sec. 1551.458. STATE CONTRIBUTION. (a) For each plan
enrollee, from the state contribution that would otherwise be made
for basic coverage for the enrollee, the state shall annually
contribute:
(1) to a high deductible health plan provided under
this subchapter, the amount that is necessary to pay the cost of
coverage under the high deductible health plan and does not exceed
the amount the state annually contributes for a full-time or
part-time employee, as applicable, who is covered by the basic
coverage; and
(2) to the enrollee's health savings account, any
remainder of the state contribution after payment of coverage under
Subdivision (1).
(b) For each plan enrollee's dependent covered under this
subchapter from the state contribution that would otherwise be made
for basic coverage for the dependent, the state shall annually
contribute:
(1) to a high deductible health plan provided under
this subchapter, the same percentage of the cost of coverage under
the high deductible health plan as the state annually contributes
for dependent coverage in the basic coverage; and
(2) to the enrollee's health savings account, as
allowed under federal law, any remainder of the state contribution
after payment for coverage under Subdivision (1).
(c) For a calendar year, the amount of state contributions
under Subsections (a)(2) and (b)(2), in the aggregate, may not
exceed the sum of the monthly limitations imposed by federal law for
health savings accounts.
Sec. 1551.459. PLAN ENROLLEE CONTRIBUTIONS. (a) Each plan
enrollee, in accordance with Section 1551.305, shall contribute any
amount required to cover the selected participation in the state
consumer-directed health plan that exceeds the state contribution
amount under Section 1551.458.
(b) A plan enrollee may contribute any amount allowed under
federal law to the enrollee's health savings account in addition to
receiving the state contribution under Section 1551.458.
(c) A plan enrollee shall make contributions under this
section in the manner prescribed by the board of trustees.
Sec. 1551.460. COORDINATION WITH CAFETERIA PLAN. (a) The
board of trustees has exclusive authority to determine the
eligibility of a plan enrollee to participate in any medical
flexible savings account that is part of a cafeteria plan offered
under this chapter.
(b) The board of trustees shall adopt rules regarding:
(1) the eligibility of a plan enrollee to participate
in any medical flexible savings account that is part of a cafeteria
plan offered under this chapter; and
(2) the coordination of benefits provided under this
subchapter and any medical flexible savings account that is part of
a cafeteria plan offered under this chapter.
(c) The rules adopted by the board of trustees under
Subsection (b) must prohibit a plan enrollee from participating in
any medical flexible savings account that would disqualify the
enrollee's health savings account from favorable tax treatment
under federal law.
Sec. 1551.461. CONFIDENTIALITY OF RECORDS. To the extent
allowed under federal law and subject to Section 1551.063, the
board of trustees or the account administrator, as applicable, may
disclose to a carrier information in an individual's records that
the board of trustees or administrator determines is necessary to
administer the state consumer-directed health plan.
Sec. 1551.462. EXEMPTION FROM EXECUTION; UNASSIGNABILITY.
A state contribution to a health savings account or a high
deductible health plan is exempt from execution and is unassignable
in the same manner and to the same extent as is an amount described
by Section 1551.011.
Sec. 1551.463. ASSISTANCE. Any state agency that the board
of trustees considers appropriate shall assist the board in
implementing and administering this subchapter.
SECTION 2. Sections 1551.063(a) and (c), Insurance Code,
are amended to read as follows:
(a) The records of a participant in the group benefits
program in the custody of the Employees Retirement System of Texas,
or of an administering firm, an account administrator, a carrier,
or another governmental entity acting on behalf of the retirement
system, are confidential and not subject to disclosure, and the
retirement system, administering firm, account administrator,
carrier, or governmental entity is not required to accept or comply
with a request for a record or information about a record or to seek
an opinion from the attorney general, because the records are
exempt from the provisions of Chapter 552, Government Code, except
as provided by this section.
(c) To accomplish the purposes of this chapter, the board of
trustees may release the records to:
(1) an administering firm, account administrator,
carrier, agent, or attorney acting on behalf of the board;
(2) another governmental entity having a legitimate
need for the information to perform a function of the board of
trustees;
(3) an authorized medical provider of the participant;
or
(4) a party in response to a subpoena issued under
applicable law.
SECTION 3. Sections 1551.354(c) and (d), Insurance Code,
are amended to read as follows:
(c) A person may not pursue a counterclaim or other cause of
action against the Employees Retirement System of Texas, a trustee,
officer, or employee of the retirement system, or a carrier, [or]
administering firm, or account administrator for the retirement
system in connection with a transaction or occurrence related to
the interpleader action.
(d) A person who violates Subsection (c) is liable for the
costs and attorney's fees incurred by the Employees Retirement
System of Texas, a trustee, officer, or employee of the retirement
system, or a carrier, [or] administering firm, or account
administrator for the retirement system as a result of the
violation.
SECTION 4. Section 1551.356(b), Insurance Code, is amended
to read as follows:
(b) A person has no standing to appeal a determination of
the executive director under this subchapter or to pursue a private
cause of action against the state, the board of trustees, the
retirement system, the executive director, an administering firm,
an account administrator, or an employee of any of those persons
based on a determination or the implementation by the board or
executive director of the type or scope of plan design features
under the group benefits program.
SECTION 5. The Employees Retirement System of Texas shall
develop the state consumer-directed health plan to be implemented
under Chapter 1551, Insurance Code, as amended by this Act,
including enrollment requirements, during the state fiscal
biennium beginning September 1, 2011, with coverage beginning
September 1, 2012.
SECTION 6. Not later than July 31, 2012, the Employees
Retirement System of Texas shall provide written information to
individuals eligible to participate in the state consumer-directed
health plan under Chapter 1551, Insurance Code, as amended by this
Act, that provides a general description of the requirements for
the plan as adopted under Chapter 1551, Insurance Code, as amended
by this Act.
SECTION 7. The Employees Retirement System of Texas shall
develop and implement the health savings account program under
Chapter 1551, Insurance Code, as amended by this Act, in a manner
that is as revenue neutral as is possible.
SECTION 8. Except as otherwise provided by this Act, this
Act takes effect September 1, 2011.