| 1 | 1 | | By: Jetton H.B. No. 2082 |
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| 2 | 2 | | |
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| 3 | 3 | | |
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| 4 | 4 | | A BILL TO BE ENTITLED |
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| 5 | 5 | | AN ACT |
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| 6 | 6 | | relating to insurance regulation of a prepaid health care plan for |
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| 7 | 7 | | certain individuals with low income. |
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| 8 | 8 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 9 | | SECTION 1. Subtitle K, Title 8, Insurance Code, is amended |
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| 10 | 10 | | by adding Chapter 1683 to read as follows: |
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| 11 | 11 | | CHAPTER 1683. PREPAID HEALTH CARE PLAN FOR CERTAIN INDIVIDUALS |
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| 12 | 12 | | WITH LOW INCOME |
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| 13 | 13 | | Sec. 1683.001. INSURANCE REGULATION OF PREPAID HEALTH CARE |
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| 14 | 14 | | PLAN FOR CERTAIN INDIVIDUALS WITH LOW INCOME. A plan for providing |
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| 15 | 15 | | health care to individuals with low income on a prepaid basis is not |
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| 16 | 16 | | considered to be engaging in the business of insurance if: |
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| 17 | 17 | | (1) eligibility in the plan is limited to: |
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| 18 | 18 | | (A) individuals not covered under any other group |
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| 19 | 19 | | insurance or health benefit plan arrangement whose incomes are at |
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| 20 | 20 | | or below 400 percent of the federal poverty level and who are: |
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| 21 | 21 | | (i) employed by a business employing 200 or |
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| 22 | 22 | | fewer eligible individuals; or |
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| 23 | 23 | | (ii) engaged in domestic service in private |
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| 24 | 24 | | households; and |
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| 25 | 25 | | (B) dependents of individuals described by |
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| 26 | 26 | | Paragraph (A); |
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| 27 | 27 | | (2) the plan is operated on a nonprofit basis under the |
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| 28 | 28 | | sponsorship of a nonprofit organization; |
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| 29 | 29 | | (3) covered primary care services are provided to |
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| 30 | 30 | | enrollees by health care practitioners who: |
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| 31 | 31 | | (A) have agreed to provide their services for |
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| 32 | 32 | | free or nominal reimbursement for out-of-pocket expenses or |
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| 33 | 33 | | expendable supplies directly related to, and incurred as a result |
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| 34 | 34 | | of, the service provided to the enrollee; and |
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| 35 | 35 | | (B) are either: |
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| 36 | 36 | | (i) health care practitioners on staff of |
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| 37 | 37 | | the sponsoring organization; or |
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| 38 | 38 | | (ii) volunteer practitioners recruited |
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| 39 | 39 | | from a county medical society; |
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| 40 | 40 | | (4) payments to outside contractors for marketing, |
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| 41 | 41 | | claims administration, and similar services total not more than 10 |
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| 42 | 42 | | percent of the total charges imposed by the plan; |
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| 43 | 43 | | (5) the plan has received the approval and endorsement |
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| 44 | 44 | | of the county medical society in consultation with the Texas |
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| 45 | 45 | | Medical Association; |
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| 46 | 46 | | (6) except as provided by Subdivision (3), the plan |
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| 47 | 47 | | does not pay a portion of any fees or charges imposed under the plan |
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| 48 | 48 | | directly or indirectly as salary to an officer or director of the |
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| 49 | 49 | | sponsoring nonprofit organization; and |
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| 50 | 50 | | (7) the sponsoring nonprofit organization files an |
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| 51 | 51 | | annual report with the commissioner in the form and manner |
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| 52 | 52 | | prescribed by the commissioner not later than the 90th day after the |
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| 53 | 53 | | end of the corporation's fiscal year that includes: |
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| 54 | 54 | | (A) the number of plan enrollees; |
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| 55 | 55 | | (B) the total number of services provided under |
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| 56 | 56 | | the plan; |
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| 57 | 57 | | (C) the plan's financial statements; |
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| 58 | 58 | | (D) the administrative costs and salaries paid by |
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| 59 | 59 | | the plan; and |
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| 60 | 60 | | (E) any other information reasonably requested |
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| 61 | 61 | | by the commissioner. |
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| 62 | 62 | | SECTION 2. This Act takes effect September 1, 2023. |
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