88R2006 RDS-D
By: Bell of Montgomery H.B. No. 351
A BILL TO BE ENTITLED
AN ACT
relating to the provision of workers' compensation insurance and
group accident and health insurance together in a packaged plan.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 10, Insurance Code, is amended
by adding Chapter 2056 to read as follows:
CHAPTER 2056. PACKAGED PLAN OF WORKERS' COMPENSATION AND ACCIDENT
AND HEALTH INSURANCE
Sec. 2056.001. DEFINITIONS. In this chapter:
(1) "Compensable injury" has the meaning assigned by
Section 401.011, Labor Code.
(2) "Packaged plan" means a plan offering a workers'
compensation policy together with a group accident and health
insurance policy as described in Section 2056.002.
(3) "Workers' compensation insurance company" means a
stock company, mutual insurance company, reciprocal or
interinsurance exchange, or Lloyd's plan authorized to engage in
the business of workers' compensation insurance in this state.
Sec. 2056.002. CONTRACT WITH ACCIDENT AND HEALTH INSURANCE
COMPANY TO PROVIDE PACKAGED PLAN. (a) A workers' compensation
insurance company may contract with an accident and health
insurance company to offer to employers a workers' compensation
insurance policy and a group accident and health insurance policy
together in one packaged plan under which employees and their
dependents are eligible for major medical expense coverage and
employees are covered for medical benefits and other benefits
required by Chapter 408, Labor Code.
(b) Nothing in this chapter authorizes a workers'
compensation insurance company to underwrite group accident and
health insurance policies. A group accident and health insurance
policy offered by a workers' compensation insurance company must be
provided by an entity that is authorized to write group accident and
health insurance and is separate from the workers' compensation
insurance company.
Sec. 2056.003. PROVISION OF MEDICAL BENEFITS THROUGH HEALTH
INSURANCE. (a) Subject to this section, a workers' compensation
insurance company that offers a packaged plan may allow for medical
benefits required under Chapter 408, Labor Code, to be provided to
employees through the group accident and health insurance policy in
the packaged plan.
(b) A packaged plan must require that benefits related to a
compensable injury other than medical benefits be provided
exclusively through the workers' compensation insurance policy in
the packaged plan. Medical benefits for a compensable injury
provided through a group accident and health insurance policy under
Subsection (a) continue to be governed by Title 5, Labor Code, and
Chapter 1305 of this code.
(c) A packaged plan offered under this section may not
impose cost-sharing requirements for workers' compensation medical
benefits that are covered under the group accident and health
insurance policy in a packaged plan.
(d) To the extent employees contribute to the premiums for
group accident and health coverage provided under a packaged plan
offered under this section, those contributions must exclude any
portion of the premiums allocated to the provision of workers'
compensation medical benefits under this section.
(e) A packaged plan offered under this section must provide
that medical examinations required under Subchapter A, Chapter 408,
Labor Code, are covered exclusively under the workers' compensation
insurance policy included in the packaged plan.
Sec. 2056.004. WORKERS' COMPENSATION OBLIGATIONS AFTER
INSOLVENCY OR TERMINATION. (a) A workers' compensation insurance
company that offers a packaged plan that allows for workers'
compensation medical benefits to be provided through the group
accident and health insurance policy in the packaged plan continues
to be liable for those workers' compensation obligations provided
through the group accident and health insurance policy if the
company issuing the group accident and health insurance policy
becomes insolvent or if the group accident and health coverage
terminates.
(b) Nothing in this chapter may be construed to relieve a
workers' compensation insurance company from any obligation to
provide benefits required by Chapter 408, Labor Code.
(c) Nothing in this chapter relieves the Texas Property and
Casualty Insurance Guaranty Association of any obligations with
respect to a workers' compensation insurance company offering a
packaged plan under this chapter.
Sec. 2056.005. EXCLUSIVE REMEDY NOT AFFECTED. Nothing in
this chapter affects the exclusivity, as provided by Section
408.001, Labor Code, of the remedy of recovery of workers'
compensation benefits for an employee covered by a packaged plan or
a legal beneficiary against the employer or an agent or employee of
the employer for the death of or a work-related injury sustained by
the employee.
Sec. 2056.006. CERTAIN CLAIMS AGAINST WORKERS'
COMPENSATION CLAIMANT PROHIBITED. (a) As provided by Section
413.042, Labor Code, a health care provider may not pursue a private
claim against a workers' compensation claimant covered by a
packaged plan for all or part of the cost of a health care service
provided by the provider except as provided by that section.
(b) A health care provider commits an administrative
violation under Title 5, Labor Code, if the provider violates
Subsection (a).
Sec. 2056.007. RULES. The commissioner shall adopt rules
as necessary to implement this chapter, including rules relating
to:
(1) establishing additional solvency requirements for
an insurance company offering a workers' compensation insurance
policy or group accident and health insurance policy under this
chapter; and
(2) modifying any disclosures otherwise required by
statute regarding accident and health policies that are not
workers' compensation when the disclosures are provided in
connection with a packaged plan.
SECTION 2. This Act takes effect September 1, 2023.