Texas 2023 - 88th Regular

Texas Senate Bill SB1618 Compare Versions

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1	1	88R8310 CJD-F
2	2	By: Johnson S.B. No. 1618
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the regulation of group family leave insurance issued
8	8	through an employer to pay for certain losses of income.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. The purpose of this Act is to bring clarity to
11	11	the laws of this state that paid family leave insurance may be
12	12	provided by any insurer authorized to write life or health
13	13	insurance, including disability income insurance, in this state and
14	14	that family leave insurance is considered a type of disability
15	15	income insurance.
16	16	SECTION 2. Subtitle B, Title 8, Insurance Code, is amended
17	17	by adding Chapter 1255 to read as follows:
18	18	CHAPTER 1255. GROUP FAMILY LEAVE INSURANCE
19	19	SUBCHAPTER A. GENERAL PROVISIONS
20	20	Sec. 1255.001. DEFINITIONS. In this chapter:
21	21	(1) "Continuing supervision by a health care provider"
22	22	includes a period of incapacity that is permanent or long-term due
23	23	to a condition for which treatment may not be effective and for
24	24	which the affected individual is not receiving active treatment by
25	25	a health care provider.
26	26	(2) "Dependent" means an individual who is under 18
27	27	years of age, or 18 years of age or older and incapable of self-care
28	28	due to a mental or physical disability, and is, in relation to an
29	29	insured:
30	30	(A) a biological, adopted, or foster child;
31	31	(B) a legal ward;
32	32	(C) a child of the insured's spouse;
33	33	(D) a child with respect to whom the insured is a
34	34	party to a suit in which the insured seeks to adopt the child; or
35	35	(E) a child of a person to whom the insured stands
36	36	in loco parentis.
37	37	(3) "Family leave" means leave taken by an employee
38	38	from work for reasons described by Section 1255.102.
39	39	(4) "Family leave insurance" means an insurance policy
40	40	issued through an employer related to a benefit program provided to
41	41	an employee to pay for a portion of the employee's income loss due
42	42	to family leave taken by the employee.
43	43	(5) "Family member," in relation to an insured,
44	44	includes a dependent, spouse, or parent or any other person defined
45	45	as a family member in the family leave insurance policy.
46	46	(6) "Health care provider" means a person licensed,
47	47	certified, or otherwise authorized by the laws of this state to
48	48	provide health care services in the ordinary course of business or
49	49	practice of a profession.
50	50	(7) "Parent" means, in relation to an insured:
51	51	(A) a biological, adoptive, or foster parent;
52	52	(B) a stepparent;
53	53	(C) a legal guardian; or
54	54	(D) a person who stood in loco parentis to the
55	55	insured when the insured was a child.
56	56	(8) "Serious health condition" means an illness,
57	57	injury, impairment, or physical or mental condition, including
58	58	transplantation preparation and recovery from surgery related to
59	59	organ or tissue donation, that involves:
60	60	(A) inpatient care in a hospital, hospice, or
61	61	residential health care facility;
62	62	(B) continuing treatment; or
63	63	(C) continuing supervision by a health care
64	64	provider.
65	65	Sec. 1255.002. APPLICABILITY OF CHAPTER. (a) This chapter
66	66	applies only to a family leave insurance policy, amendment, or
67	67	rider to a group disability policy delivered or issued for delivery
68	68	in this state by a life, health, and accident insurance company.
69	69	(b) Notwithstanding Chapter 1701 and except as provided by
70	70	Section 1255.108, this chapter does not apply to a certificate of
71	71	family leave insurance delivered to a resident in this state if the
72	72	group policy was delivered or issued for delivery in another state.
73	73	(c) This chapter applies to an insurance company authorized
74	74	to write life, health, and accident insurance in this state,
75	75	including a stipulated premium company operating under Chapter 884.
76	76	(d) This chapter does not apply to:
77	77	(1) a society, company, or other insurer whose
78	78	activities are exempt by statute from department regulation and
79	79	that is entitled by statute to a certificate from the department
80	80	that shows the entity's exempt status;
81	81	(2) a credit accident and health insurance policy
82	82	issued under Chapter 1153;
83	83	(3) a workers' compensation insurance policy;
84	84	(4) a liability insurance policy, with or without
85	85	supplementary expense coverage;
86	86	(5) a reinsurance policy or contract;
87	87	(6) a blanket or group insurance policy, except as
88	88	otherwise provided by this chapter; or
89	89	(7) a life insurance endowment or annuity contract, or
90	90	a contract supplemental to a life insurance endowment or annuity
91	91	contract, if the contract or supplemental contract contains only
92	92	provisions relating to accident and health insurance that:
93	93	(A) provide additional benefits in case of
94	94	accidental death, accidental dismemberment, or accidental loss of
95	95	sight; or
96	96	(B) operate to:
97	97	(i) safeguard the contract or supplemental
98	98	contract against lapse; or
99	99	(ii) give a special surrender value, a
100	100	special benefit, or an annuity if the insured or annuitant becomes
101	101	totally and permanently disabled, as defined by the contract or
102	102	supplemental contract.
103	103	Sec. 1255.003. CONSIDERATION AS DISABILITY INCOME
104	104	INSURANCE. A family leave insurance policy is considered a type of
105	105	disability income insurance for all purposes under this code.
106	106	Sec. 1255.004. APPLICATION OF OTHER LAW; CONFLICTS. (a)
107	107	The provisions of Subchapter B, Chapter 1251, governing eligibility
108	108	for group accident and health insurance apply to govern the
109	109	eligibility of a group for purposes of this chapter to the extent
110	110	those provisions do not conflict with this chapter. This chapter
111	111	prevails over Subchapter B, Chapter 1251, if there is a conflict.
112	112	(b) Notwithstanding any other law, the law of the state in
113	113	which the group or master policy providing family leave insurance
114	114	is delivered or issued for delivery governs disputes between the
115	115	insurer, group policyholder, and certificate holder.
116	116	Sec. 1255.005. RULEMAKING AUTHORITY. The commissioner may
117	117	adopt reasonable rules as necessary to implement this chapter.
118	118	SUBCHAPTER B. MINIMUM POLICY STANDARDS
119	119	Sec. 1255.101. COMPLIANCE WITH MINIMUM STANDARDS FOR
120	120	BENEFITS. A group family leave insurance policy must meet the
121	121	minimum standards for benefits as provided by this subchapter.
122	122	Sec. 1255.102. FAMILY LEAVE BENEFITS. A group family leave
123	123	insurance policy may provide benefits for any leave taken by an
124	124	insured from work to:
125	125	(1) participate in providing care, including physical
126	126	or psychological care, for a family member of the insured made
127	127	necessary by a serious health condition of the family member;
128	128	(2) bond with the insured's child during the first 12
129	129	months after the child's birth, or the first 12 months after the
130	130	placement of the child for adoption or foster care with the insured;
131	131	(3) address a qualifying exigency, as interpreted
132	132	under the Family and Medical Leave Act of 1993 (29 U.S.C. Section
133	133	2612(a)(1)(E)) and 29 C.F.R. Sections 825.126(b)(1)-(8), arising
134	134	from the fact that the spouse, dependent, or parent of the insured
135	135	is on active duty or has been notified of an impending call or order
136	136	to active duty in the armed forces of the United States, including
137	137	the National Guard and armed forces reserves;
138	138	(4) care for a family member described by Subdivision
139	139	(3) who is injured in the line of duty; or
140	140	(5) take other leave to provide care for a family
141	141	member or other family leave as specified in the policy.
142	142	Sec. 1255.103. EXPLANATION OF COVERED FAMILY LEAVE REASONS.
143	143	A group family leave insurance policy must provide the details
144	144	regarding and requirements for each covered family leave reason.
145	145	Sec. 1255.104. BENEFIT PERIOD. (a) A group family leave
146	146	insurance policy must establish the length of family leave benefits
147	147	that are available for each covered family leave reason.
148	148	(b) The length of family leave benefits available for a
149	149	covered family leave reason may not be less than two weeks during a
150	150	period of 52 consecutive calendar weeks.
151	151	(c) A group family leave insurance policy may calculate the
152	152	52 consecutive calendar weeks by any of the following methods:
153	153	(1) a calendar year;
154	154	(2) a fixed period starting on a particular date,
155	155	including an effective or anniversary date;
156	156	(3) the period measured forward from the insured's
157	157	first day of family leave;
158	158	(4) a rolling period measured from the insured's first
159	159	day of family leave; or
160	160	(5) any other method that is specified in the policy.
161	161	Sec. 1255.105. WAITING PERIOD. (a) A group family leave
162	162	insurance policy must specify whether there is an unpaid waiting
163	163	period.
164	164	(b) If a group family leave insurance policy contains an
165	165	unpaid waiting period, the terms of the unpaid waiting period may
166	166	include:
167	167	(1) whether the waiting period runs over a consecutive
168	168	calendar day period;
169	169	(2) whether the waiting period is counted toward the
170	170	annual allotment of family leave benefits or is in addition to the
171	171	annual allotment of family leave benefits;
172	172	(3) whether the waiting period must be met only once
173	173	per benefit year or must be met for each separate claim for
174	174	benefits; and
175	175	(4) whether the insured may work or receive paid time
176	176	off or other compensation by the employer during the waiting
177	177	period.
178	178	Sec. 1255.106. AMOUNT OF FAMILY LEAVE BENEFITS; OTHER
179	179	INCOME. (a) A group family leave insurance policy must specify:
180	180	(1) the amount of benefits that will be paid for
181	181	covered family leave reasons;
182	182	(2) the definition of wages or other income on which
183	183	the amount of family leave benefits is based; and
184	184	(3) the method for calculating those wages or other
185	185	income.
186	186	(b) If the family leave benefits are subject to offsets for
187	187	wages or other income received by the insured or for which the
188	188	insured may be eligible, the group family leave insurance policy
189	189	must specify:
190	190	(1) which wages or other income may be offset; and
191	191	(2) the circumstances under which the wages or other
192	192	income may be offset.
193	193	Sec. 1255.107. PERMISSIBLE LIMITATIONS, EXCLUSIONS, OR
194	194	REDUCTIONS. (a) A group family leave insurance policy that limits,
195	195	excludes, or reduces eligibility for family leave benefits under
196	196	this chapter must state the limit, exclusion, or reduction in the
197	197	policy.
198	198	(b) Permissible limitations, exclusions, or reductions in
199	199	the policy include a limitation, exclusion, or reduction for:
200	200	(1) a period of family leave for which the required
201	201	notice and medical certification have not been provided as
202	202	prescribed by the policy;
203	203	(2) family leave related to a serious health condition
204	204	or other harm to a family member brought about by the wilful
205	205	intention of the insured;
206	206	(3) a period of family leave during which the insured
207	207	performed work for compensation or profit;
208	208	(4) a period of family leave for which the insured is
209	209	eligible to receive money from the insured's employer or from a fund
210	210	to which the employer has contributed;
211	211	(5) a period of family leave in which the insured is
212	212	eligible to receive benefits under another statutory program or
213	213	employer-sponsored program, including unemployment insurance
214	214	benefits, workers' compensation benefits, statutory disability
215	215	benefits, statutory paid leave benefits, or paid time off from the
216	216	employer's paid leave policy;
217	217	(6) a period of family leave beginning before the
218	218	insured becomes eligible for family leave benefits under the
219	219	policy; or
220	220	(7) periods of family leave during which more than one
221	221	person covered under the policy seeks family leave for the same
222	222	family member.
223	223	Sec. 1255.108. CERTIFICATE OF INSURANCE. (a) An insurer
224	224	providing family leave insurance shall issue a certificate of
225	225	insurance to each employee or member of the insured group.
226	226	(b) The certificate of insurance must include:
227	227	(1) a summary of the essential features of the paid
228	228	family leave insurance coverage and benefits available to the
229	229	insured;
230	230	(2) the limitations, exclusions, or reductions;
231	231	(3) the annual and lifetime policy limits; and
232	232	(4) the person to whom the benefits are payable.
233	233	(c) An insurer may file a certificate issued to an insured
234	234	in this state for a group policy providing family leave insurance
235	235	that was delivered or issued for delivery in another state with the
236	236	department for informational purposes.
237	237	(d) An insurer is not required to file or receive approval
238	238	under Chapter 1701 for a certificate for a foreign group.
239	239	SECTION 3. This Act applies only to a family leave insurance
240	240	policy, amendment, or rider delivered, issued for delivery, or
241	241	renewed on or after January 1, 2024.
242	242	SECTION 4. This Act takes effect September 1, 2023.