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