87R1705 SCL-D
By: Jetton H.B. No. 1369
A BILL TO BE ENTITLED
AN ACT
relating to regulation of health care cost-sharing organizations.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Subtitle K, Title 8, Insurance
Code, is amended to read as follows:
SUBTITLE K. HEALTH CARE COST SHARING [MINISTRIES]
SECTION 2. Subtitle K, Title 8, Insurance Code, is amended
by adding Chapter 1682 to read as follows:
CHAPTER 1682. HEALTH CARE COST-SHARING ORGANIZATIONS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1682.0001. DEFINITIONS. In this chapter:
(1) "Health care cost-sharing organization" means an
entity that facilitates the sharing of health care expenses among
the entity's participants. The term does not include a health
benefit plan issuer or a health care sharing ministry described by
Section 1681.001.
(2) "Participant" means an individual enrolled in a
health care cost-sharing organization to voluntarily share health
care expenses with other individuals enrolled in the organization.
Sec. 1682.0002. EXEMPTION. Notwithstanding any other
provision of this code, a health care cost-sharing organization
that acts in accordance with this chapter is not considered to be
engaging in the business of insurance.
Sec. 1682.0003. CONSTRUCTION OF CHAPTER. This chapter may
not be construed to assign responsibility for a person's health
care expenses to any other person.
SUBCHAPTER B. REGULATION OF HEALTH CARE COST-SHARING ORGANIZATIONS
Sec. 1682.0051. HEALTH CARE COST SHARING. (a) A health care
cost-sharing organization shall facilitate health care cost
sharing among its participants by matching participants with health
care bills to participants with the ability to provide financial
assistance in accordance with the criteria established by the
organization.
(b) In facilitating health care cost sharing, a health care
cost-sharing organization:
(1) shall collect resources from participants to
provide payments for a participant's health care bills through the
direct contributions from one participant to another without the
pooling of accounts; and
(2) may not have a financial interest in a
participant's decision on whether to share money.
Sec. 1682.0052. COMMUNITY MAINTENANCE. A health care
cost-sharing organization may suggest an amount that participants
may voluntarily contribute to community maintenance. The
organization may not require a participant to make a contribution
or assume a risk for the community maintenance.
Sec. 1682.0053. REQUIRED DISCLOSURES. (a) A health care
cost-sharing organization shall provide the following written
disclosure to prospective participants and annually to
participants:
"Health care cost-sharing organizations facilitate the
sharing of health care expenses but are not insurance companies.
Neither their guidelines nor their plans of operation are an
insurance policy. Whether anyone chooses to assist you with your
health care bills will be totally voluntary because no other
participant will be compelled by law to contribute toward your
health care bills.
"As such, participation in the cost-sharing coverage or a
subscription to any of its documents should never be considered to
be or treated like insurance. Regardless of whether you receive any
payment for health care expenses or whether this organization
continues to operate, you are always personally responsible for the
payment of your own health care bills. Complaints concerning any
health care cost-sharing organization may be reported to the office
of the Texas attorney general."
(b) A health care cost-sharing organization shall provide a
written disclosure of all administrative fees and costs to
prospective participants and annually to participants.
Sec. 1682.0054. MONTHLY STATEMENT. A health care
cost-sharing organization shall provide a written monthly
statement to all participants that lists:
(1) the total dollar amount of qualified needs
submitted to the organization; and
(2) the amount actually published or assigned to
participants for their contribution.
Sec. 1682.0055. PARTICIPANT CARD. A health care
cost-sharing organization shall ensure that a card issued to a
participant for the purpose of presentation to a health care
provider clearly indicates that the participant is part of a health
care cost-sharing organization that is not engaging in the business
of insurance.
Sec. 1682.0056. DISCOUNT HEALTH CARE PROGRAM PROHIBITED. A
health care cost-sharing organization may not operate a discount
health care program as defined by Section 7001.001.
Sec. 1682.0057. COMPLAINT; INJUNCTION. (a) A person who
reasonably believes that a health care cost-sharing organization is
not complying with this chapter may file a written complaint with
the attorney general.
(b) The attorney general may investigate a complaint
received under Subsection (a). If the attorney general determines
that a violation has occurred, the attorney general may bring a
civil action in the name of the state for an injunction against a
health care cost-sharing organization that is violating this
chapter.
SECTION 3. This Act takes effect September 1, 2021.