83R9185 PMO-F
By: Deuell S.B. No. 995
A BILL TO BE ENTITLED
AN ACT
relating to allowing employers to issue individual insurance plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1501.002(5), Insurance Code, is amended
to read as follows:
(5) "Health benefit plan" means a group or [,]
blanket[, or franchise] insurance policy, a certificate issued
under a group policy, a group hospital service contract, or a group
subscriber contract or evidence of coverage issued by a health
maintenance organization that provides benefits for health care
services. The term does not include:
(A) accident-only or disability income insurance
coverage or a combination of accident-only and disability income
insurance coverage;
(B) credit-only insurance coverage;
(C) disability insurance coverage;
(D) coverage for a specified disease or illness;
(E) Medicare services under a federal contract;
(F) Medicare supplement and Medicare Select
benefit plans regulated in accordance with federal law;
(G) long-term care coverage or benefits, nursing
home care coverage or benefits, home health care coverage or
benefits, community-based care coverage or benefits, or any
combination of those coverages or benefits;
(H) coverage that provides limited-scope dental
or vision benefits;
(I) coverage provided by a single service health
maintenance organization;
(J) workers' compensation insurance coverage or
similar insurance coverage;
(K) coverage provided through a jointly managed
trust authorized under 29 U.S.C. Section 141 et seq. that contains a
plan of benefits for employees that is negotiated in a collective
bargaining agreement governing wages, hours, and working
conditions of the employees that is authorized under 29 U.S.C.
Section 157;
(L) hospital indemnity or other fixed indemnity
insurance coverage;
(M) reinsurance contracts issued on a stop-loss,
quota-share, or similar basis;
(N) short-term major medical contracts;
(O) liability insurance coverage, including
general liability insurance coverage and automobile liability
insurance coverage, and coverage issued as a supplement to
liability insurance coverage, including automobile medical payment
insurance coverage;
(P) coverage for on-site medical clinics;
(Q) coverage that provides other limited
benefits specified by federal regulations; or
(R) other coverage that:
(i) is similar to the coverage described by
this subdivision under which benefits for medical care are
secondary or incidental to other coverage benefits; and
(ii) is specified by federal regulations.
SECTION 2. Sections 1501.003, 1501.004, and 1501.005,
Insurance Code, are amended to read as follows:
Sec. 1501.003. APPLICABILITY: SMALL EMPLOYER HEALTH
BENEFIT PLANS. A [An individual or] group health benefit plan is a
small employer health benefit plan subject to Subchapters C-H if it
provides health care benefits covering two or more eligible
employees of a small employer and:
(1) the employer pays a portion of the premium or
benefits;
(2) the employer or a covered individual treats the
health benefit plan as part of a plan or program for purposes of
Section 106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section
106 or 162); or
(3) the health benefit plan is an employee welfare
benefit plan under 29 C.F.R. Section 2510.3-1(j).
Sec. 1501.004. APPLICABILITY: LARGE EMPLOYER HEALTH
BENEFIT PLANS. A [An individual or] group health benefit plan is a
large employer health benefit plan subject to Subchapters C and M if
the plan provides health care benefits to eligible employees of a
large employer and:
(1) the employer pays a portion of the premium or
benefits;
(2) the employer or a covered individual treats the
health benefit plan as part of a plan or program for purposes of
Section 106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section
106 or 162); or
(3) the health benefit plan is an employee welfare
benefit plan under 29 C.F.R. Section 2510.3-1(j).
Sec. 1501.005. EXCEPTION: CERTAIN INDIVIDUALLY
UNDERWRITTEN POLICIES. This [Except as provided by Section
1501.003 or 1501.004, this] chapter does not apply to an individual
health insurance policy that is subject to individual underwriting,
even if the premium is paid through a payroll deduction method.
SECTION 3. This Act applies only to an insurance policy that
is delivered, issued for delivery, or renewed on or after January 1,
2014. A policy delivered, issued for delivery, or renewed before
January 1, 2014, is governed by the law as it existed immediately
before the effective date of this Act, and that law is continued in
effect for that purpose.
SECTION 4. This Act takes effect September 1, 2013.