Texas 2021 - 87th Regular

Texas House Bill HB2761 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~87R18195~~ SMT-D
	1	+	87R5029 SMT-D
2	2		By: Israel H.B. No. 2761
3		-	Substitute the following for H.B. No. 2761:
4		-	By: Oliverson C.S.H.B. No. 2761
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to disclosure requirements for accident and health
10	8		coverage and health expense arrangements marketed to individuals.
11	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	10		SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
13	11		by adding Chapter 1223 to read as follows:
14	12		CHAPTER 1223. MANDATORY DISCLOSURES FOR ALTERNATIVE HEALTH
15	13		COVERAGE AND HEALTH EXPENSE ARRANGEMENTS
16	14		SUBCHAPTER A. GENERAL PROVISIONS
17	15		Sec. 1223.001. DEFINITION. In this chapter, "issuer" means
18	16		a person who markets, sells, issues, or operates an individual
19	17		health benefit plan or health expense arrangement governed by this
20	18		chapter.
21		-	Sec. 1223.002. APPLICABILITY. (a) Except as provided by
22		-	Subsection (b) or Section 1223.003 but notwithstanding any other
23		-	law, this chapter applies to a health benefit plan or health expense
24		-	arrangement marketed to an individual to provide health benefit
25		-	coverage or pay for health care expenses, including:
26		-	(1) a health care sharing ministry operated under
	19	+	Sec. 1223.002. APPLICABILITY. Except as provided by
	20	+	Section 1223.003 but notwithstanding any other law, this chapter
	21	+	applies to a health benefit plan or health expense arrangement
	22	+	marketed to an individual to provide health benefit coverage or pay
	23	+	for health care expenses, including:
	24	+	(1) an individual accident and health insurance policy
	25	+	governed by Chapter 1201;
	26	+	(2) a group accident and health insurance policy
	27	+	governed by Chapter 1251 that is marketed to an individual;
	28	+	(3) individual health maintenance organization
	29	+	coverage;
	30	+	(4) a health care sharing ministry operated under
27	31		Chapter 1681;
28		-	(2) a discount health care program governed by Chapter
	32	+	(5) a discount health care program governed by Chapter
29	33		7001;
30		-	(3) a direct primary care arrangement governed by
31		-	Subchapter F, Chapter 162, Occupations Code, but only if sold or
32		-	marketed by a person other than a physician contracting directly
33		-	with a patient; or
34		-	(4) any other plan or arrangement the commissioner
	34	+	(6) a direct primary care arrangement governed by
	35	+	Subchapter F, Chapter 162, Occupations Code; or
	36	+	(7) any other plan or arrangement the commissioner
35	37		determines is or could be marketed to an individual as an
36		-	alternative to major medical coverage.
37		-	(b) Except as provided by Section 1223.003 and
38		-	notwithstanding any other law, this chapter applies to an
39		-	individual accident and health insurance policy governed by Chapter
40		-	1201 or a group accident and health insurance policy governed by
41		-	Chapter 1251 and marketed to an individual if the policy is a fixed
42		-	indemnity, specified disease, or medical indemnity policy and:
43		-	(1) the policy is marketed by the insurer or a third
44		-	party as an alternative to major medical coverage; or
45		-	(2) the policy:
46		-	(A) has a range of benefits that is similar to the
47		-	range of benefits in major medical coverage; and
48		-	(B) may be sold as stand-alone coverage because
49		-	the issuer does not require a purchaser to be covered by major
50		-	medical coverage.
	38	+	alternative or supplement to an employer-provided health benefit
	39	+	plan or health benefit plan coverage regulated under the Patient
	40	+	Protection and Affordable Care Act (Pub. L. No. 111-148).
51	41		Sec. 1223.003. EXCEPTION. This chapter does not apply to a
52	42		health benefit plan or health expense arrangement if:
53	43		(1) the issuer is required to submit a summary of
54	44		benefits and coverage for the plan or arrangement to the United
55		-	States secretary of health and human services under 42 U.S.C.
56		-	~~Section~~ 300gg-15; or
	45	+	States secretary of health and human services under 42 U.S.C. Sec.
	46	+	300gg-15; or
57	47		(2) the issuer is required to provide a disclosure
58	48		form for the plan or arrangement under Section 1509.002.
59	49		Sec. 1223.004. RULES. The commissioner may adopt rules
60		-	necessary to implement this chapter. Section 2001.0045, Government
61		-	Code, does not apply to rules adopted under this section.
	50	+	necessary to implement this chapter.
62	51		SUBCHAPTER B. DISCLOSURE REQUIRED
63	52		Sec. 1223.051. DISCLOSURE FORM TEMPLATE. (a) The
64	53		commissioner by rule shall prescribe a disclosure form template for
65	54		each type of health benefit plan or health expense arrangement to
66	55		which this chapter applies.
67	56		(b) The commissioner shall ensure that the disclosure form
68	57		template is presented in plain language and in a standardized
69	58		format designed to facilitate consumer understanding.
70	59		(c) The commissioner may prescribe as many disclosure form
71	60		templates as necessary to account for each type of health benefit
72	61		plan or health expense arrangement.
73		-	(d) The disclosure ~~form template may include the following~~
74		-	information~~, if applicable,~~ that is ~~tailored to the type of health~~
75		-	benefit plan or health expense ~~arrangement described by the~~
76		-	template:
	62	+	(d) Except as provided by Subsection (e), the disclosure
	63	+	form template must include the following information that is
	64	+	tailored to the type of health benefit plan or health expense
	65	+	arrangement described by the template:
77	66		(1) a statement:
78	67		(A) of whether the plan or arrangement is
79	68		insurance; and
80	69		(B) of what, if any, guarantees are made of
81		-	payment for or related to health care services;
82		-	(2) the duration of the coverage or the arrangement;
83		-	(3) if the plan or arrangement is subject to renewal, a
84		-	statement:
	70	+	payment for health care services;
	71	+	(2) the duration of coverage;
	72	+	(3) a statement:
85	73		(A) of whether:
86	74		(i) the plan or arrangement may be renewed
87	75		at the option of the enrollee or participant with no new
88	76		underwriting;
89	77		(ii) the plan or arrangement is only able to
90	78		be renewed at the option of the issuer after underwriting; or
91	79		(iii) the plan or arrangement may not be
92		-	renewed; ~~and~~
	80	+	renewed;
93	81		(B) of whether, on renewal, the issuer is able
94	82		to:
95	83		(i) increase the premium or assess a direct
96	84		fee, contribution, or similar cost; or
97	85		(ii) make changes to the plan or
98	86		arrangement terms, including benefits and limits, based on an
99	87		individual's health status;
100		-	(4) ~~a statement~~ that the expiration of the plan or
	88	+	(C) that the expiration of the plan or
101	89		arrangement is not a qualifying life event that would make a person
102		-	eligible for a special enrollment period, if applicable;
103		-	(5) ~~a statement~~ that the plan or arrangement may
104		-	~~expire~~ outside of the open enrollment period under the Patient
105		-	~~Protection~~ and Affordable Care Act (Pub. L. No. 111-148);
106		-	(6) to the extent the information is available, the
	90	+	eligible for a special enrollment period, if applicable; and
	91	+	(D) that the plan or arrangement may expire
	92	+	outside of the open enrollment period under the Patient Protection
	93	+	and Affordable Care Act (Pub. L. No. 111-148);
	94	+	(4) to the extent the information is available, the
107	95		dates of the next three open enrollment periods under the Patient
108		-	Protection and Affordable Care Act (Pub. L. No. 111-148);
109		-	(7) whether the plan or arrangement contains any
	96	+	Protection and Affordable Care Act (Pub. L. No. 111-148) following
	97	+	the date the plan or arrangement expires;
	98	+	(5) whether the plan or arrangement contains any
110	99		limitations or exclusions to preexisting conditions;
111		-	(8) the maximum dollar amount payable or shareable
112		-	under the plan or arrangement;
113		-	(9) the primary cost-sharing features under the plan
114		-	or arrangement, including a deductible or amount that is not
115		-	shareable, and the health care services to which the cost-sharing
116		-	features apply;
117		-	(10) whether the following health care services are
118		-	covered or shareable and any limits relevant to that coverage or
119		-	shareability:
	100	+	(6) the maximum dollar amount payable under the plan
	101	+	or arrangement;
	102	+	(7) the deductibles under the plan or arrangement and
	103	+	the health care services to which the deductibles apply;
	104	+	(8) whether the following health care services are
	105	+	covered and any limits to the coverage:
120	106		(A) prescription drugs;
121	107		(B) mental health services;
122	108		(C) substance abuse treatment;
123	109		(D) maternity care;
124	110		(E) hospitalization;
125	111		(F) surgery;
126	112		(G) emergency health care; and
127	113		(H) preventive health care;
128		-	(11) for a plan or arrangement other than a
	114	+	(9) for a plan or arrangement other than a
129	115		traditional, major medical health benefit plan, information on
130	116		unique aspects of the plan or arrangement and how it differs from
131	117		traditional, major medical coverage that the commissioner
132	118		determines is important to facilitate consumer understanding; and
133		-	(12) any other information the commissioner
	119	+	(10) any other information the commissioner
134	120		determines is important for a purchaser or participant of a plan or
135	121		arrangement.
136	122		(e) The commissioner may omit information described by
137	123		Subsection (d) in a disclosure form template if the information is
138	124		inapplicable to the type of plan or arrangement for which the
139	125		template is prescribed.
140		-	(f) The department shall incorporate the content for an
141		-	outline of coverage required by Section 1201.108 into the
142		-	disclosure form template for a policy to which that section
143		-	applies.
144	126		Sec. 1223.052. DISCLOSURE FORM REVIEW. (a) Before an
145		-	issuer may sell, market, or provide an insurance product that is
146		-	subject to a determination by the commissioner under Section
147		-	1223.002(a)(4) or that is described by Section 1223.002(b), the
148		-	issuer shall submit to the department for approval in the manner
149		-	prescribed by commissioner rule a disclosure form on the product.
150		-	(b) Except as provided by Subsection (a), an issuer
151		-	providing a health benefit plan or health expense arrangement
152		-	described by Section 1223.002(a) to a consumer shall submit to the
153		-	department for informational purposes in the manner prescribed by
154		-	commissioner rule a disclosure form for each plan or arrangement
155		-	offered by the issuer.
156		-	(c) Except as provided by Subsection (d), the disclosure
	127	+	issuer may sell, market, or provide a health benefit plan or health
	128	+	expense arrangement to a consumer, the issuer shall submit to the
	129	+	department for approval in the manner prescribed by department rule
	130	+	a disclosure form for each plan or arrangement offered by the
	131	+	issuer.
	132	+	(b) Except as provided by Subsection (c), the disclosure
157	133		form must use the disclosure form template prescribed by the
158	134		commissioner under Section 1223.051 for the health benefit plan or
159	135		health expense arrangement described by the form.
160		-	(d) An issuer may modify the disclosure form template for a
	136	+	(c) An issuer may modify the disclosure form template for a
161	137		health benefit plan or health expense arrangement that is not able
162	138		to be accurately represented by the template. If the issuer
163	139		modifies the template, the issuer shall clearly identify any
164	140		changes made and explain the reason for those changes when the
165		-	issuer submits the form under Subsection (a) or (b).
166		-	(e) The department shall approve a disclosure form
167		-	submitted under Subsection (a) if the form uses the appropriate
168		-	disclosure form template and accurately describes the health
169		-	benefit plan or health expense arrangement in a manner that is
170		-	easily understandable to a consumer.
	141	+	issuer submits the form for approval under Subsection (a).
	142	+	(d) The department shall approve a disclosure form if the
	143	+	form uses the appropriate disclosure form template and accurately
	144	+	describes the health benefit plan or health expense arrangement in
	145	+	a manner that is easily understandable to a consumer.
171	146		Sec. 1223.053. DISCLOSURE TO CONSUMER. (a) An issuer shall
172		-	provide to a consumer the disclosure form ~~submitted~~ under Section
173		-	1223.052 ~~along with an application, if applicable~~:
	147	+	provide to a consumer the disclosure form approved under Section
	148	+	1223.052:
174	149		(1) before the earliest of the time that the consumer
175	150		completes an application, makes an initial premium payment, or
176	151		makes any other payment in connection with coverage under or
177	152		participation in the health benefit plan or health expense
178	153		arrangement; and
179	154		(2) at the time the policy, certificate, or
180	155		arrangement is issued or entered into.
181	156		(b) An issuer shall ensure that a consumer signs the
182	157		disclosure form before the issuer accepts an application or
183	158		payment for or issues or enters into the health benefit plan or
184	159		health expense arrangement. An electronic signature must comply
185	160		with Chapter 35 and rules adopted under this chapter.
186	161		Sec. 1223.054. RETENTION. An issuer shall retain a signed
187	162		disclosure form until the fifth anniversary of the date the issuer
188	163		receives the form, and the issuer shall make the form available to
189	164		the department on request.
190	165		Sec. 1223.055. HEALTH CARE SHARING MINISTRIES. The
191	166		commissioner shall consult with the attorney general in prescribing
192	167		the disclosure form template applicable to a health care sharing
193	168		ministry, and the template must incorporate the notice described by
194	169		Section 1681.002.
195	170		Sec. 1223.056. DIRECT PRIMARY CARE ARRANGEMENTS. The
196	171		commissioner shall consult with the Texas Medical Board in
197	172		prescribing the disclosure form template applicable to a direct
198	173		primary care arrangement, and the template must incorporate the
199	174		disclosure required by Section 162.256, Occupations Code.
200	175		Sec. 1223.057. ENFORCEMENT. The department may take an
201	176		enforcement action under Subtitle B, Title 2, against an issuer
202	177		that violates this chapter.
203		-	SECTION 2. Not later than ~~September~~ 1, 2022, the
204		-	~~commissioner~~ of insurance shall adopt rules necessary to implement
205		-	~~Chapter 1223,~~ Insurance Code, as added by this Act.
	178	+	SECTION 2. Not later than January 1, 2022, the commissioner
	179	+	of insurance shall adopt rules necessary to implement Chapter 1223,
	180	+	Insurance Code, as added by this Act.
206	181		SECTION 3. Chapter 1223, Insurance Code, as added by this
207	182		Act, applies only to a health benefit plan or health expense
208	183		arrangement delivered, issued for delivery, entered into, or
209		-	renewed on or after ~~September~~ 1, 2022.
	184	+	renewed on or after January 1, 2022.
210	185		SECTION 4. This Act takes effect September 1, 2021.