87R18195 SMT-D
By: Israel H.B. No. 2761
Substitute the following for H.B. No. 2761:
By: Oliverson C.S.H.B. No. 2761
A BILL TO BE ENTITLED
AN ACT
relating to disclosure requirements for accident and health
coverage and health expense arrangements marketed to individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
by adding Chapter 1223 to read as follows:
CHAPTER 1223. MANDATORY DISCLOSURES FOR ALTERNATIVE HEALTH
COVERAGE AND HEALTH EXPENSE ARRANGEMENTS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1223.001. DEFINITION. In this chapter, "issuer" means
a person who markets, sells, issues, or operates an individual
health benefit plan or health expense arrangement governed by this
chapter.
Sec. 1223.002. APPLICABILITY. (a) Except as provided by
Subsection (b) or Section 1223.003 but notwithstanding any other
law, this chapter applies to a health benefit plan or health expense
arrangement marketed to an individual to provide health benefit
coverage or pay for health care expenses, including:
(1) a health care sharing ministry operated under
Chapter 1681;
(2) a discount health care program governed by Chapter
7001;
(3) a direct primary care arrangement governed by
Subchapter F, Chapter 162, Occupations Code, but only if sold or
marketed by a person other than a physician contracting directly
with a patient; or
(4) any other plan or arrangement the commissioner
determines is or could be marketed to an individual as an
alternative to major medical coverage.
(b) Except as provided by Section 1223.003 and
notwithstanding any other law, this chapter applies to an
individual accident and health insurance policy governed by Chapter
1201 or a group accident and health insurance policy governed by
Chapter 1251 and marketed to an individual if the policy is a fixed
indemnity, specified disease, or medical indemnity policy and:
(1) the policy is marketed by the insurer or a third
party as an alternative to major medical coverage; or
(2) the policy:
(A) has a range of benefits that is similar to the
range of benefits in major medical coverage; and
(B) may be sold as stand-alone coverage because
the issuer does not require a purchaser to be covered by major
medical coverage.
Sec. 1223.003. EXCEPTION. This chapter does not apply to a
health benefit plan or health expense arrangement if:
(1) the issuer is required to submit a summary of
benefits and coverage for the plan or arrangement to the United
States secretary of health and human services under 42 U.S.C.
Section 300gg-15; or
(2) the issuer is required to provide a disclosure
form for the plan or arrangement under Section 1509.002.
Sec. 1223.004. RULES. The commissioner may adopt rules
necessary to implement this chapter. Section 2001.0045, Government
Code, does not apply to rules adopted under this section.
SUBCHAPTER B. DISCLOSURE REQUIRED
Sec. 1223.051. DISCLOSURE FORM TEMPLATE. (a) The
commissioner by rule shall prescribe a disclosure form template for
each type of health benefit plan or health expense arrangement to
which this chapter applies.
(b) The commissioner shall ensure that the disclosure form
template is presented in plain language and in a standardized
format designed to facilitate consumer understanding.
(c) The commissioner may prescribe as many disclosure form
templates as necessary to account for each type of health benefit
plan or health expense arrangement.
(d) The disclosure form template may include the following
information, if applicable, that is tailored to the type of health
benefit plan or health expense arrangement described by the
template:
(1) a statement:
(A) of whether the plan or arrangement is
insurance; and
(B) of what, if any, guarantees are made of
payment for or related to health care services;
(2) the duration of the coverage or the arrangement;
(3) if the plan or arrangement is subject to renewal, a
statement:
(A) of whether:
(i) the plan or arrangement may be renewed
at the option of the enrollee or participant with no new
underwriting;
(ii) the plan or arrangement is only able to
be renewed at the option of the issuer after underwriting; or
(iii) the plan or arrangement may not be
renewed; and
(B) of whether, on renewal, the issuer is able
to:
(i) increase the premium or assess a direct
fee, contribution, or similar cost; or
(ii) make changes to the plan or
arrangement terms, including benefits and limits, based on an
individual's health status;
(4) a statement that the expiration of the plan or
arrangement is not a qualifying life event that would make a person
eligible for a special enrollment period, if applicable;
(5) a statement that the plan or arrangement may
expire outside of the open enrollment period under the Patient
Protection and Affordable Care Act (Pub. L. No. 111-148);
(6) to the extent the information is available, the
dates of the next three open enrollment periods under the Patient
Protection and Affordable Care Act (Pub. L. No. 111-148);
(7) whether the plan or arrangement contains any
limitations or exclusions to preexisting conditions;
(8) the maximum dollar amount payable or shareable
under the plan or arrangement;
(9) the primary cost-sharing features under the plan
or arrangement, including a deductible or amount that is not
shareable, and the health care services to which the cost-sharing
features apply;
(10) whether the following health care services are
covered or shareable and any limits relevant to that coverage or
shareability:
(A) prescription drugs;
(B) mental health services;
(C) substance abuse treatment;
(D) maternity care;
(E) hospitalization;
(F) surgery;
(G) emergency health care; and
(H) preventive health care;
(11) for a plan or arrangement other than a
traditional, major medical health benefit plan, information on
unique aspects of the plan or arrangement and how it differs from
traditional, major medical coverage that the commissioner
determines is important to facilitate consumer understanding; and
(12) any other information the commissioner
determines is important for a purchaser or participant of a plan or
arrangement.
(e) The commissioner may omit information described by
Subsection (d) in a disclosure form template if the information is
inapplicable to the type of plan or arrangement for which the
template is prescribed.
(f) The department shall incorporate the content for an
outline of coverage required by Section 1201.108 into the
disclosure form template for a policy to which that section
applies.
Sec. 1223.052. DISCLOSURE FORM REVIEW. (a) Before an
issuer may sell, market, or provide an insurance product that is
subject to a determination by the commissioner under Section
1223.002(a)(4) or that is described by Section 1223.002(b), the
issuer shall submit to the department for approval in the manner
prescribed by commissioner rule a disclosure form on the product.
(b) Except as provided by Subsection (a), an issuer
providing a health benefit plan or health expense arrangement
described by Section 1223.002(a) to a consumer shall submit to the
department for informational purposes in the manner prescribed by
commissioner rule a disclosure form for each plan or arrangement
offered by the issuer.
(c) Except as provided by Subsection (d), the disclosure
form must use the disclosure form template prescribed by the
commissioner under Section 1223.051 for the health benefit plan or
health expense arrangement described by the form.
(d) An issuer may modify the disclosure form template for a
health benefit plan or health expense arrangement that is not able
to be accurately represented by the template. If the issuer
modifies the template, the issuer shall clearly identify any
changes made and explain the reason for those changes when the
issuer submits the form under Subsection (a) or (b).
(e) The department shall approve a disclosure form
submitted under Subsection (a) if the form uses the appropriate
disclosure form template and accurately describes the health
benefit plan or health expense arrangement in a manner that is
easily understandable to a consumer.
Sec. 1223.053. DISCLOSURE TO CONSUMER. (a) An issuer shall
provide to a consumer the disclosure form submitted under Section
1223.052 along with an application, if applicable:
(1) before the earliest of the time that the consumer
completes an application, makes an initial premium payment, or
makes any other payment in connection with coverage under or
participation in the health benefit plan or health expense
arrangement; and
(2) at the time the policy, certificate, or
arrangement is issued or entered into.
(b) An issuer shall ensure that a consumer signs the
disclosure form before the issuer accepts an application or
payment for or issues or enters into the health benefit plan or
health expense arrangement. An electronic signature must comply
with Chapter 35 and rules adopted under this chapter.
Sec. 1223.054. RETENTION. An issuer shall retain a signed
disclosure form until the fifth anniversary of the date the issuer
receives the form, and the issuer shall make the form available to
the department on request.
Sec. 1223.055. HEALTH CARE SHARING MINISTRIES. The
commissioner shall consult with the attorney general in prescribing
the disclosure form template applicable to a health care sharing
ministry, and the template must incorporate the notice described by
Section 1681.002.
Sec. 1223.056. DIRECT PRIMARY CARE ARRANGEMENTS. The
commissioner shall consult with the Texas Medical Board in
prescribing the disclosure form template applicable to a direct
primary care arrangement, and the template must incorporate the
disclosure required by Section 162.256, Occupations Code.
Sec. 1223.057. ENFORCEMENT. The department may take an
enforcement action under Subtitle B, Title 2, against an issuer
that violates this chapter.
SECTION 2. Not later than September 1, 2022, the
commissioner of insurance shall adopt rules necessary to implement
Chapter 1223, Insurance Code, as added by this Act.
SECTION 3. Chapter 1223, Insurance Code, as added by this
Act, applies only to a health benefit plan or health expense
arrangement delivered, issued for delivery, entered into, or
renewed on or after September 1, 2022.
SECTION 4. This Act takes effect September 1, 2021.