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Texas House Bill HB1996

Texas 2023 - 88th Regular

Texas House Bill HB1996 Compare Versions

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11 H.B. No. 1996
22
33
44 AN ACT
55 relating to the regulation of group family leave insurance issued
66 through an employer to pay for certain losses of income.
77 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
88 SECTION 1. The purpose of this Act is to bring clarity to
99 the laws of this state that paid family leave insurance may be
1010 provided by any insurer authorized to write life or health
1111 insurance, including disability income insurance, in this state and
1212 that family leave insurance is considered a type of disability
1313 income insurance.
1414 SECTION 2. Subtitle B, Title 8, Insurance Code, is amended
1515 by adding Chapter 1255 to read as follows:
1616 CHAPTER 1255. GROUP FAMILY LEAVE INSURANCE
1717 SUBCHAPTER A. GENERAL PROVISIONS
1818 Sec. 1255.001. DEFINITIONS. In this chapter:
1919 (1) "Continuing supervision by a health care provider"
2020 includes a period of incapacity that is permanent or long-term due
2121 to a condition for which treatment may not be effective and for
2222 which the affected individual is not receiving active treatment by
2323 a health care provider.
2424 (2) "Dependent" means an individual who is under 18
2525 years of age, or 18 years of age or older and incapable of self-care
2626 due to a mental or physical disability, and is, in relation to an
2727 insured:
2828 (A) a biological, adopted, or foster child;
2929 (B) a legal ward;
3030 (C) a child of the insured's spouse;
3131 (D) a child with respect to whom the insured is a
3232 party to a suit in which the insured seeks to adopt the child; or
3333 (E) a child of a person to whom the insured stands
3434 in loco parentis.
3535 (3) "Family leave" means leave taken by an employee
3636 from work for reasons described by Section 1255.102.
3737 (4) "Family leave insurance" means an insurance policy
3838 issued through an employer related to a benefit program provided to
3939 an employee to pay for a portion of the employee's income loss due
4040 to family leave taken by the employee.
4141 (5) "Family member," in relation to an insured,
4242 includes a dependent, spouse, or parent or any other person defined
4343 as a family member in the family leave insurance policy.
4444 (6) "Health care provider" means a person licensed,
4545 certified, or otherwise authorized by the laws of this state to
4646 provide health care services in the ordinary course of business or
4747 practice of a profession.
4848 (7) "Parent" means, in relation to an insured:
4949 (A) a biological, adoptive, or foster parent;
5050 (B) a stepparent;
5151 (C) a legal guardian; or
5252 (D) a person who stood in loco parentis to the
5353 insured when the insured was a child.
5454 (8) "Serious health condition" means an illness,
5555 injury, impairment, or physical or mental condition, including
5656 transplantation preparation and recovery from surgery related to
5757 organ or tissue donation, that involves:
5858 (A) inpatient care in a hospital, hospice, or
5959 residential health care facility;
6060 (B) continuing treatment; or
6161 (C) continuing supervision by a health care
6262 provider.
6363 Sec. 1255.002. APPLICABILITY OF CHAPTER. (a) This chapter
6464 applies only to a family leave insurance policy, amendment, or
6565 rider to a group disability policy delivered or issued for delivery
6666 in this state by a life, health, and accident insurance company.
6767 (b) Notwithstanding Chapter 1701 and except as provided by
6868 Section 1255.108, this chapter does not apply to a certificate of
6969 family leave insurance delivered to a resident in this state if the
7070 group policy was delivered or issued for delivery in another state.
7171 (c) This chapter applies to an insurance company authorized
7272 to write life, health, and accident insurance in this state,
7373 including a stipulated premium company operating under Chapter 884.
7474 (d) This chapter does not apply to:
7575 (1) a society, company, or other insurer whose
7676 activities are exempt by statute from department regulation and
7777 that is entitled by statute to a certificate from the department
7878 that shows the entity's exempt status;
7979 (2) a credit accident and health insurance policy
8080 issued under Chapter 1153;
8181 (3) a workers' compensation insurance policy;
8282 (4) a liability insurance policy, with or without
8383 supplementary expense coverage;
8484 (5) a reinsurance policy or contract;
8585 (6) a blanket or group insurance policy, except as
8686 otherwise provided by this chapter; or
8787 (7) a life insurance endowment or annuity contract, or
8888 a contract supplemental to a life insurance endowment or annuity
8989 contract, if the contract or supplemental contract contains only
9090 provisions relating to accident and health insurance that:
9191 (A) provide additional benefits in case of
9292 accidental death, accidental dismemberment, or accidental loss of
9393 sight; or
9494 (B) operate to:
9595 (i) safeguard the contract or supplemental
9696 contract against lapse; or
9797 (ii) give a special surrender value, a
9898 special benefit, or an annuity if the insured or annuitant becomes
9999 totally and permanently disabled, as defined by the contract or
100100 supplemental contract.
101101 Sec. 1255.003. CONSIDERATION AS DISABILITY INCOME
102102 INSURANCE. A family leave insurance policy is considered a type of
103103 disability income insurance for all purposes under this code.
104104 Sec. 1255.004. APPLICATION OF OTHER LAW; CONFLICTS. (a)
105105 The provisions of Subchapter B, Chapter 1251, governing eligibility
106106 for group accident and health insurance apply to govern the
107107 eligibility of a group for purposes of this chapter to the extent
108108 those provisions do not conflict with this chapter. This chapter
109109 prevails over Subchapter B, Chapter 1251, if there is a conflict.
110110 (b) Notwithstanding any other law, the law of the state in
111111 which the group or master policy providing family leave insurance
112112 is delivered or issued for delivery governs disputes between the
113113 insurer, group policyholder, and certificate holder.
114114 Sec. 1255.005. RULEMAKING AUTHORITY. The commissioner may
115115 adopt reasonable rules as necessary to implement this chapter.
116116 SUBCHAPTER B. MINIMUM POLICY STANDARDS
117117 Sec. 1255.101. COMPLIANCE WITH MINIMUM STANDARDS FOR
118118 BENEFITS. A group family leave insurance policy must meet the
119119 minimum standards for benefits as provided by this subchapter.
120120 Sec. 1255.102. FAMILY LEAVE BENEFITS. A group family leave
121121 insurance policy may provide benefits for any leave taken by an
122122 insured from work to:
123123 (1) participate in providing care, including physical
124124 or psychological care, for a family member of the insured made
125125 necessary by a serious health condition of the family member;
126126 (2) bond with the insured's child during the first 12
127127 months after the child's birth, or the first 12 months after the
128128 placement of the child for adoption or foster care with the insured;
129129 (3) address a qualifying exigency, as interpreted
130130 under the Family and Medical Leave Act of 1993 (29 U.S.C. Section
131131 2612(a)(1)(E)) and 29 C.F.R. Sections 825.126(b)(1)-(8), arising
132132 from the fact that the spouse, dependent, or parent of the insured
133133 is on active duty or has been notified of an impending call or order
134134 to active duty in the armed forces of the United States, including
135135 the National Guard and armed forces reserves;
136136 (4) care for a family member described by Subdivision
137137 (3) who is injured in the line of duty; or
138138 (5) take other leave to provide care for a family
139139 member or other family leave as specified in the policy.
140140 Sec. 1255.103. EXPLANATION OF COVERED FAMILY LEAVE REASONS.
141141 A group family leave insurance policy must provide the details
142142 regarding and requirements for each covered family leave reason.
143143 Sec. 1255.104. BENEFIT PERIOD. (a) A group family leave
144144 insurance policy must establish the length of family leave benefits
145145 that are available for each covered family leave reason.
146146 (b) The length of family leave benefits available for a
147147 covered family leave reason may not be less than two weeks during a
148148 period of 52 consecutive calendar weeks.
149149 (c) A group family leave insurance policy may calculate the
150150 52 consecutive calendar weeks by any of the following methods:
151151 (1) a calendar year;
152152 (2) a fixed period starting on a particular date,
153153 including an effective or anniversary date;
154154 (3) the period measured forward from the insured's
155155 first day of family leave;
156156 (4) a rolling period measured from the insured's first
157157 day of family leave; or
158158 (5) any other method that is specified in the policy.
159159 Sec. 1255.105. WAITING PERIOD. (a) A group family leave
160160 insurance policy must specify whether there is an unpaid waiting
161161 period.
162162 (b) If a group family leave insurance policy contains an
163163 unpaid waiting period, the terms of the unpaid waiting period may
164164 include:
165165 (1) whether the waiting period runs over a consecutive
166166 calendar day period;
167167 (2) whether the waiting period is counted toward the
168168 annual allotment of family leave benefits or is in addition to the
169169 annual allotment of family leave benefits;
170170 (3) whether the waiting period must be met only once
171171 per benefit year or must be met for each separate claim for
172172 benefits; and
173173 (4) whether the insured may work or receive paid time
174174 off or other compensation by the employer during the waiting
175175 period.
176176 Sec. 1255.106. AMOUNT OF FAMILY LEAVE BENEFITS; OTHER
177177 INCOME. (a) A group family leave insurance policy must specify:
178178 (1) the amount of benefits that will be paid for
179179 covered family leave reasons;
180180 (2) the definition of wages or other income on which
181181 the amount of family leave benefits is based; and
182182 (3) the method for calculating those wages or other
183183 income.
184184 (b) If the family leave benefits are subject to offsets for
185185 wages or other income received by the insured or for which the
186186 insured may be eligible, the group family leave insurance policy
187187 must specify:
188188 (1) which wages or other income may be offset; and
189189 (2) the circumstances under which the wages or other
190190 income may be offset.
191191 Sec. 1255.107. PERMISSIBLE LIMITATIONS, EXCLUSIONS, OR
192192 REDUCTIONS. (a) A group family leave insurance policy that limits,
193193 excludes, or reduces eligibility for family leave benefits under
194194 this chapter must state the limit, exclusion, or reduction in the
195195 policy.
196196 (b) Permissible limitations, exclusions, or reductions in
197197 the policy include a limitation, exclusion, or reduction for:
198198 (1) a period of family leave for which the required
199199 notice and medical certification have not been provided as
200200 prescribed by the policy;
201201 (2) family leave related to a serious health condition
202202 or other harm to a family member brought about by the wilful
203203 intention of the insured;
204204 (3) a period of family leave during which the insured
205205 performed work for compensation or profit;
206206 (4) a period of family leave for which the insured is
207207 eligible to receive money from the insured's employer or from a fund
208208 to which the employer has contributed;
209209 (5) a period of family leave in which the insured is
210210 eligible to receive benefits under another statutory program or
211211 employer-sponsored program, including unemployment insurance
212212 benefits, workers' compensation benefits, statutory disability
213213 benefits, statutory paid leave benefits, or paid time off from the
214214 employer's paid leave policy;
215215 (6) a period of family leave beginning before the
216216 insured becomes eligible for family leave benefits under the
217217 policy; or
218218 (7) periods of family leave during which more than one
219219 person covered under the policy seeks family leave for the same
220220 family member.
221221 Sec. 1255.108. CERTIFICATE OF INSURANCE. (a) An insurer
222222 providing family leave insurance shall issue a certificate of
223223 insurance to each employee or member of the insured group.
224224 (b) The certificate of insurance must include:
225225 (1) a summary of the essential features of the paid
226226 family leave insurance coverage and benefits available to the
227227 insured;
228228 (2) the limitations, exclusions, or reductions;
229229 (3) the annual and lifetime policy limits; and
230230 (4) the person to whom the benefits are payable.
231231 (c) An insurer may file a certificate issued to an insured
232232 in this state for a group policy providing family leave insurance
233233 that was delivered or issued for delivery in another state with the
234234 department for informational purposes.
235235 (d) An insurer is not required to file or receive approval
236236 under Chapter 1701 for a certificate for a foreign group.
237237 SECTION 3. This Act applies only to a family leave insurance
238238 policy, amendment, or rider delivered, issued for delivery, or
239239 renewed on or after January 1, 2024.
240240 SECTION 4. This Act takes effect September 1, 2023.
241241 ______________________________ ______________________________
242242 President of the Senate Speaker of the House
243243 I certify that H.B. No. 1996 was passed by the House on April
244244 25, 2023, by the following vote: Yeas 146, Nays 2, 1 present, not
245245 voting.
246246 ______________________________
247247 Chief Clerk of the House
248248 I certify that H.B. No. 1996 was passed by the Senate on May
249249 22, 2023, by the following vote: Yeas 31, Nays 0.
250250 ______________________________
251251 Secretary of the Senate
252252 APPROVED: _____________________
253253 Date
254254 _____________________
255255 Governor