By: Frank H.B. No. 3752
A BILL TO BE ENTITLED
AN ACT
relating to the provision of health benefits coverage through the
creation of the Texas Mutual Health Coverage Plan.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 2054.001, Insurance Code, is amended to
read as follows:
Sec. 2054.001. DEFINITIONS. In this chapter:
(1) "Board" means the board of directors of the
company.
(2) Repealed by Acts 2007, 80th Leg., R.S., Ch. 730,
Sec. 3B.056, eff. September 1, 2007.
(3) "Company" means the Texas Mutual Insurance
Company.
(4) "Workers' compensation insurance" means insurance
for a risk under:
(A) Subtitle A, Title 5, Labor Code;
(B) Chapter 504, Labor Code;
(C) the Longshore and Harbor Workers'
Compensation Act (33 U.S.C. Section 901 et seq.);
(D) the Federal Mine Safety and Health Act of
1977 (30 U.S.C. Section 801 et seq.);
(E) the Defense Base Act (42 U.S.C. Sections
1651-1654);
(F) the federal Employers' Liability Act (45
U.S.C. Section 51 et seq.);
(G) the Nonappropriated Fund Instrumentalities
Act (5 U.S.C. Sections 8171-8173);
(H) the Outer Continental Shelf Lands Act (43
U.S.C. Section 1331 et seq.); or
(I) the Merchant Marine Act of 1920 (46 App.
U.S.C. Section 861 et seq.).
(5) "Texas Mutual Health Coverage Plan" means a health
benefit plan offered to individual residents or small employers in
the state outside of the workers' compensation marketplace.
(6) "Small employer" means a person who employed an
average of at least two employees but not more than 50 employees on
business days during the preceding calendar year and who employs at
least two employees on the first day of the plan year. For purposes
of this definition, a partnership is the employer of a partner.
This term applies only to the company's health benefits coverage
business.
SECTION 2. Section 2054.151, Insurance Code, is amended to
read as follows:
Sec. 2054.151. PURPOSE OF COMPANY. The company shall:
(1) serve as a competitive force in the workers'
compensation and health benefit marketplaces;
(2) guarantee the availability of workers'
compensation insurance in this state; and
(3) serve as an insurer of last resort as provided by
Subchapter H.; and
(4) offer a competitive health coverage option to
residents and small employers of this state.
SECTION 3. Section 2054.152, Insurance Code, is amended to
read as follows:
Sec. 2054.152. PAYMENT OF TAXES, FEES, AND OTHER CHARGES.
The company shall pay the following in the same manner as a domestic
mutual insurance company authorized to engage in the business of
insurance and to write workers' compensation insurance or health
benefit coverage in this state:
(1) taxes, including maintenance and premium taxes;
(2) fees; and
(3) payments due in lieu of taxes.
SECTION 4. Section 2054.155, Insurance Code, is amended to
read as follows:
Sec. 2054.155. REQUIRED RESERVES. The company shall
establish and maintain reserves for losses on an actuarily sound
basis in accordance with Chapter 424 as applicable and Chapter 426.
SECTION 5. Subchapter G, Chapter Section 2054, Insurance
Code, is amended to read as follows:
SUBCHAPTER G. ISSUANCE OF WORKERS' COMPENSATION COVERAGE
Sec. 2054.301. APPLICATION FOR COVERAGE. An application to
the company for workers' compensation insurance coverage must be:
(1) made on the form prescribed by the company; and
(2) submitted directly by the applicant or by a
general property and casualty agent on behalf of the applicant.
Sec. 2054.302. POLICY FORMS. The company shall use the
uniform policy and standard policy forms prescribed by the
department under Section 2052.002.
Sec. 2054.303. DENIAL OF COVERAGE BASED ON CREDIT RISK. The
company may refuse to write workers' compensation insurance
coverage for an applicant that the company identifies as a credit
risk unless the applicant, before a policy is issued:
(1) pays the total estimated premium and related
charges; or
(2) provides security for payment of the total
estimated premium and related charges.
Sec. 2054.304. CANCELLATION AND NONRENEWAL. The company
may cancel or refuse to renew coverage on a workers' compensation
policyholder as provided by Section 406.008, Labor Code.
SECTION 6. The title of Subchapter H, Chapter Section 2054,
Insurance Code, is amended to read as follows:
SUBCHAPTER H. COMPANY AS WORKERS' COMPENSATION INSURER OF LAST
RESORT
SECTION 7. Chapter 2054, Insurance Code, is amended by
adding Subchapter M to read as follows:
SUBCHAPTER M. TEXAS MUTUAL HEALTH COVERAGE PLAN
Sec. 2054.554 AUTHORITY TO DEVELOP AND OPERATE A HEALTH
BENEFITS COVERAGE PLAN. (a) The company is authorized, based upon
available funding, to develop, market, and operate a health
benefits coverage plan to be offered to individuals who are
residents of the state, or small employers.
(b) The board shall adopt any necessary bylaws or rules,
with approval of the Texas Department of Insurance Commissioner, to
establish standards governing the individuals and small employers
eligible to purchase a Texas Mutual Health Coverage plan, benefit
packages and plan offerings, which may include high-deductible
catastrophic care options and the use of health savings accounts
and flexible spending accounts, and multitiered premiums.
Sec. 2054.555. EXEMPTION. Notwithstanding any other
provision of this code, this health benefit plan is not considered
to be an insurance product and, as such, is not subject to
applicable state and federal regulations governing traditional
health insurance coverage.
Sec. 2054.556. ANNUAL STATEMENT; FILING FEE FOR HEALTH
BENEFITS COVERAGE BUSINESS. (a) Not later than March 1 of each
year, the company shall:
(1) prepare a statement showing the condition of the
company as it relates to its health benefits coverage division on
December 31 of the preceding year; and
(2) deliver the statement to the department
accompanied by a filing fee in the amount determined under the
commissioner.
(b) The statement must be under oath of two of the company's
officers and show in detail the following information only as it
relates to the company's health benefit coverage business:
(1) the character of the company's assets and
liabilities on December 31 of the preceding year;
(2) the amount and character of business transacted
and money received during the preceding year;
(3) how money was spent during the preceding year;
(4) the number and amount of the company's policies in
force in this state on that date; and
(5) the total amount of the company's coverage
policies in force on that date.
SECTION 8. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2021.