Texas 2023 - 88th Regular

Texas Senate Bill SB1307 Compare Versions

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Old	New	Differences
1	1	88R2007 RDS-F
2	2	By: Hancock S.B. No. 1307
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to multiple employer welfare arrangements.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subchapter A, Chapter 846, Insurance Code, is
10	10	amended by adding Section 846.0035 to read as follows:
11	11	Sec. 846.0035. APPLICABILITY OF CERTAIN LAWS TO ASSOCIATION
12	12	PROVIDING HEALTH BENEFITS. (a) This section applies only to a
13	13	multiple employer welfare arrangement:
14	14	(1) that was issued an initial certificate of
15	15	authority under Section 846.054 on or after January 1, 2024; or
16	16	(2) that elects to be bound by this section in the
17	17	manner prescribed by the commissioner.
18	18	(b) A multiple employer welfare arrangement that provides a
19	19	comprehensive health benefit plan, as determined by the
20	20	commissioner, is subject to the following laws as if the
21	21	arrangement were an insurer, individuals entitled to coverage under
22	22	the plan were insureds, and the health benefits were provided
23	23	through an insurance policy:
24	24	(1) Chapter 421;
25	25	(2) Chapter 422;
26	26	(3) Subchapters C, F, and K, Chapter 1451; and
27	27	(4) Chapter 4201.
28	28	(c) A multiple employer welfare arrangement that provides a
29	29	comprehensive health benefit plan, as determined by the
30	30	commissioner, that is determined by the commissioner to be
31	31	structured in the manner of a preferred provider benefit plan or an
32	32	exclusive provider benefit plan as defined in Section 1301.001 is
33	33	subject to the following laws as if the arrangement were an insurer,
34	34	individuals entitled to coverage under the plan were insureds, and
35	35	the health benefits were provided through an insurance policy:
36	36	(1) Chapter 1301; and
37	37	(2) Chapter 1467.
38	38	SECTION 2. Section 846.052(b), Insurance Code, is amended
39	39	to read as follows:
40	40	(b) The application form must be completed and submitted
41	41	along with all information required by the commissioner, including:
42	42	(1) a copy of each organizational document;
43	43	(2) current financial statements of the arrangement;
44	44	(3) a fully detailed statement indicating the plan
45	45	under which the arrangement proposes to transact business;
46	46	(4) an initial actuarial opinion in compliance with
47	47	the requirements of Section 846.153(a)(2) and subject to Section
48	48	846.157(b); and
49	49	(5) demonstration [a statement] by the applicant
50	50	[certifying] that the arrangement is in compliance with all
51	51	applicable federal and state laws [provisions of the Employee
52	52	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
53	53	seq.)].
54	54	SECTION 3. Section 846.053, Insurance Code, is amended by
55	55	amending Subsections (b) and (c) and adding Subsection (d-1) to
56	56	read as follows:
57	57	(b) The employers in the multiple employer welfare
58	58	arrangement must:
59	59	(1) be members of an association or group of five or
60	60	more businesses that are in the same trade or industry, including
61	61	closely related businesses that provide support, services, or
62	62	supplies primarily to that trade or industry; or
63	63	(2) for a multiple employer welfare arrangement to
64	64	which Section 846.0035 applies, each have a principal place of
65	65	business in the same region that does not exceed the boundaries of
66	66	this state or the boundaries of a metropolitan statistical area
67	67	designated by the United States Office of Management and Budget.
68	68	(c) If the employers in the multiple employer welfare
69	69	arrangement are members of an association, the association must:
70	70	(1) be engaged in substantial activity for its
71	71	members other than sponsorship of an employee welfare benefit plan;
72	72	and
73	73	(2) if Section 846.0035 does not apply to the multiple
74	74	employer welfare arrangement, have been in existence for at least
75	75	two years before engaging in any activities relating to providing
76	76	employee health benefits to its members.
77	77	(d-1) For purposes of a multiple employer welfare
78	78	arrangement to which Section 846.0035 applies, a working owner of a
79	79	trade or business without employees may qualify as both an employer
80	80	and as an employee of the trade or industry for the purposes of this
81	81	section. In this subsection, "working owner" means an individual
82	82	who:
83	83	(1) has an ownership right of any nature in a trade or
84	84	business, whether incorporated or unincorporated, including a
85	85	partner and other self-employed individual;
86	86	(2) earns wages or self-employment income from the
87	87	trade or business for providing personal services to the trade or
88	88	business; and
89	89	(3) either:
90	90	(A) works on average at least 20 hours per week or
91	91	at least 80 hours per month providing personal services to the
92	92	working owner's trade or business; or
93	93	(B) has wages or self-employment income from the
94	94	individual's trade or business that at least equals the
95	95	individual's cost of coverage for participation by the individual
96	96	and any covered beneficiaries in the group health plan sponsored by
97	97	the group or association in which the individual is participating.
98	98	SECTION 4. This Act takes effect September 1, 2023.