Texas 2021 - 87th Regular

Texas Senate Bill SB2047 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	87R5029 SMT-D
2	2	By: Menéndez S.B. No. 2047
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to disclosure requirements for accident and health
8	8	coverage and health expense arrangements marketed to individuals.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1223 to read as follows:
12	12	CHAPTER 1223. MANDATORY DISCLOSURES FOR ALTERNATIVE HEALTH
13	13	COVERAGE AND HEALTH EXPENSE ARRANGEMENTS
14	14	SUBCHAPTER A. GENERAL PROVISIONS
15	15	Sec. 1223.001. DEFINITION. In this chapter, "issuer" means
16	16	a person who markets, sells, issues, or operates an individual
17	17	health benefit plan or health expense arrangement governed by this
18	18	chapter.
19	19	Sec. 1223.002. APPLICABILITY. Except as provided by
20	20	Section 1223.003 but notwithstanding any other law, this chapter
21	21	applies to a health benefit plan or health expense arrangement
22	22	marketed to an individual to provide health benefit coverage or pay
23	23	for health care expenses, including:
24	24	(1) an individual accident and health insurance policy
25	25	governed by Chapter 1201;
26	26	(2) a group accident and health insurance policy
27	27	governed by Chapter 1251 that is marketed to an individual;
28	28	(3) individual health maintenance organization
29	29	coverage;
30	30	(4) a health care sharing ministry operated under
31	31	Chapter 1681;
32	32	(5) a discount health care program governed by Chapter
33	33	7001;
34	34	(6) a direct primary care arrangement governed by
35	35	Subchapter F, Chapter 162, Occupations Code; or
36	36	(7) any other plan or arrangement the commissioner
37	37	determines is or could be marketed to an individual as an
38	38	alternative or supplement to an employer-provided health benefit
39	39	plan or health benefit plan coverage regulated under the Patient
40	40	Protection and Affordable Care Act (Pub. L. No. 111-148).
41	41	Sec. 1223.003. EXCEPTION. This chapter does not apply to a
42	42	health benefit plan or health expense arrangement if:
43	43	(1) the issuer is required to submit a summary of
44	44	benefits and coverage for the plan or arrangement to the United
45	45	States secretary of health and human services under 42 U.S.C. Sec.
46	46	300gg-15; or
47	47	(2) the issuer is required to provide a disclosure
48	48	form for the plan or arrangement under Section 1509.002.
49	49	Sec. 1223.004. RULES. The commissioner may adopt rules
50	50	necessary to implement this chapter.
51	51	SUBCHAPTER B. DISCLOSURE REQUIRED
52	52	Sec. 1223.051. DISCLOSURE FORM TEMPLATE. (a) The
53	53	commissioner by rule shall prescribe a disclosure form template for
54	54	each type of health benefit plan or health expense arrangement to
55	55	which this chapter applies.
56	56	(b) The commissioner shall ensure that the disclosure form
57	57	template is presented in plain language and in a standardized
58	58	format designed to facilitate consumer understanding.
59	59	(c) The commissioner may prescribe as many disclosure form
60	60	templates as necessary to account for each type of health benefit
61	61	plan or health expense arrangement.
62	62	(d) Except as provided by Subsection (e), the disclosure
63	63	form template must include the following information that is
64	64	tailored to the type of health benefit plan or health expense
65	65	arrangement described by the template:
66	66	(1) a statement:
67	67	(A) of whether the plan or arrangement is
68	68	insurance; and
69	69	(B) of what, if any, guarantees are made of
70	70	payment for health care services;
71	71	(2) the duration of coverage;
72	72	(3) a statement:
73	73	(A) of whether:
74	74	(i) the plan or arrangement may be renewed
75	75	at the option of the enrollee or participant with no new
76	76	underwriting;
77	77	(ii) the plan or arrangement is only able to
78	78	be renewed at the option of the issuer after underwriting; or
79	79	(iii) the plan or arrangement may not be
80	80	renewed;
81	81	(B) of whether, on renewal, the issuer is able
82	82	to:
83	83	(i) increase the premium or assess a direct
84	84	fee, contribution, or similar cost; or
85	85	(ii) make changes to the plan or
86	86	arrangement terms, including benefits and limits, based on an
87	87	individual's health status;
88	88	(C) that the expiration of the plan or
89	89	arrangement is not a qualifying life event that would make a person
90	90	eligible for a special enrollment period, if applicable; and
91	91	(D) that the plan or arrangement may expire
92	92	outside of the open enrollment period under the Patient Protection
93	93	and Affordable Care Act (Pub. L. No. 111-148);
94	94	(4) to the extent the information is available, the
95	95	dates of the next three open enrollment periods under the Patient
96	96	Protection and Affordable Care Act (Pub. L. No. 111-148) following
97	97	the date the plan or arrangement expires;
98	98	(5) whether the plan or arrangement contains any
99	99	limitations or exclusions to preexisting conditions;
100	100	(6) the maximum dollar amount payable under the plan
101	101	or arrangement;
102	102	(7) the deductibles under the plan or arrangement and
103	103	the health care services to which the deductibles apply;
104	104	(8) whether the following health care services are
105	105	covered and any limits to the coverage:
106	106	(A) prescription drugs;
107	107	(B) mental health services;
108	108	(C) substance abuse treatment;
109	109	(D) maternity care;
110	110	(E) hospitalization;
111	111	(F) surgery;
112	112	(G) emergency health care; and
113	113	(H) preventive health care;
114	114	(9) for a plan or arrangement other than a
115	115	traditional, major medical health benefit plan, information on
116	116	unique aspects of the plan or arrangement and how it differs from
117	117	traditional, major medical coverage that the commissioner
118	118	determines is important to facilitate consumer understanding; and
119	119	(10) any other information the commissioner
120	120	determines is important for a purchaser or participant of a plan or
121	121	arrangement.
122	122	(e) The commissioner may omit information described by
123	123	Subsection (d) in a disclosure form template if the information is
124	124	inapplicable to the type of plan or arrangement for which the
125	125	template is prescribed.
126	126	Sec. 1223.052. DISCLOSURE FORM REVIEW. (a) Before an
127	127	issuer may sell, market, or provide a health benefit plan or health
128	128	expense arrangement to a consumer, the issuer shall submit to the
129	129	department for approval in the manner prescribed by department rule
130	130	a disclosure form for each plan or arrangement offered by the
131	131	issuer.
132	132	(b) Except as provided by Subsection (c), the disclosure
133	133	form must use the disclosure form template prescribed by the
134	134	commissioner under Section 1223.051 for the health benefit plan or
135	135	health expense arrangement described by the form.
136	136	(c) An issuer may modify the disclosure form template for a
137	137	health benefit plan or health expense arrangement that is not able
138	138	to be accurately represented by the template. If the issuer
139	139	modifies the template, the issuer shall clearly identify any
140	140	changes made and explain the reason for those changes when the
141	141	issuer submits the form for approval under Subsection (a).
142	142	(d) The department shall approve a disclosure form if the
143	143	form uses the appropriate disclosure form template and accurately
144	144	describes the health benefit plan or health expense arrangement in
145	145	a manner that is easily understandable to a consumer.
146	146	Sec. 1223.053. DISCLOSURE TO CONSUMER. (a) An issuer shall
147	147	provide to a consumer the disclosure form approved under Section
148	148	1223.052:
149	149	(1) before the earliest of the time that the consumer
150	150	completes an application, makes an initial premium payment, or
151	151	makes any other payment in connection with coverage under or
152	152	participation in the health benefit plan or health expense
153	153	arrangement; and
154	154	(2) at the time the policy, certificate, or
155	155	arrangement is issued or entered into.
156	156	(b) An issuer shall ensure that a consumer signs the
157	157	disclosure form before the issuer accepts an application or
158	158	payment for or issues or enters into the health benefit plan or
159	159	health expense arrangement. An electronic signature must comply
160	160	with Chapter 35 and rules adopted under this chapter.
161	161	Sec. 1223.054. RETENTION. An issuer shall retain a signed
162	162	disclosure form until the fifth anniversary of the date the issuer
163	163	receives the form, and the issuer shall make the form available to
164	164	the department on request.
165	165	Sec. 1223.055. HEALTH CARE SHARING MINISTRIES. The
166	166	commissioner shall consult with the attorney general in prescribing
167	167	the disclosure form template applicable to a health care sharing
168	168	ministry, and the template must incorporate the notice described by
169	169	Section 1681.002.
170	170	Sec. 1223.056. DIRECT PRIMARY CARE ARRANGEMENTS. The
171	171	commissioner shall consult with the Texas Medical Board in
172	172	prescribing the disclosure form template applicable to a direct
173	173	primary care arrangement, and the template must incorporate the
174	174	disclosure required by Section 162.256, Occupations Code.
175	175	Sec. 1223.057. ENFORCEMENT. The department may take an
176	176	enforcement action under Subtitle B, Title 2, against an issuer
177	177	that violates this chapter.
178	178	SECTION 2. Not later than January 1, 2022, the commissioner
179	179	of insurance shall adopt rules necessary to implement Chapter 1223,
180	180	Insurance Code, as added by this Act.
181	181	SECTION 3. Chapter 1223, Insurance Code, as added by this
182	182	Act, applies only to a health benefit plan or health expense
183	183	arrangement delivered, issued for delivery, entered into, or
184	184	renewed on or after January 1, 2022.
185	185	SECTION 4. This Act takes effect September 1, 2021.