Texas 2023 - 88th Regular

Texas Senate Bill SB457 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R1760 SCL-D
2	2	By: Menéndez S.B. No. 457
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to disclosure requirements for health benefit plans and
8	8	health expense arrangements marketed to individuals.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1223 to read as follows:
12	12	CHAPTER 1223. MANDATORY DISCLOSURES FOR CERTAIN HEALTH BENEFIT
13	13	PLANS AND HEALTH EXPENSE ARRANGEMENTS
14	14	SUBCHAPTER A. GENERAL PROVISIONS
15	15	Sec. 1223.001. DEFINITION. In this chapter, "issuer" means
16	16	a person who markets, sells, issues, or operates a health benefit
17	17	plan or health expense arrangement governed by this chapter.
18	18	Sec. 1223.002. APPLICABILITY. Except as provided by
19	19	Section 1223.003 but notwithstanding any other law, this chapter
20	20	applies to a health benefit plan or health expense arrangement
21	21	marketed to an individual to provide health benefit coverage or pay
22	22	for health care expenses, including:
23	23	(1) an individual accident and health insurance policy
24	24	governed by Chapter 1201;
25	25	(2) a group accident and health insurance policy
26	26	governed by Chapter 1251 that is marketed to an individual;
27	27	(3) individual health maintenance organization
28	28	coverage;
29	29	(4) a health care sharing ministry operated under
30	30	Chapter 1681;
31	31	(5) a discount health care program governed by Chapter
32	32	7001;
33	33	(6) a direct primary care arrangement governed by
34	34	Subchapter F, Chapter 162, Occupations Code; or
35	35	(7) any other plan or arrangement the commissioner
36	36	determines is or could be marketed to an individual as an
37	37	alternative or supplement to an employer-provided health benefit
38	38	plan or health benefit plan coverage regulated under the Patient
39	39	Protection and Affordable Care Act (Pub. L. No. 111-148).
40	40	Sec. 1223.003. EXCEPTION. This chapter does not apply to a
41	41	health benefit plan or health expense arrangement if:
42	42	(1) the issuer is required to submit a summary of
43	43	benefits and coverage for the plan or arrangement to the United
44	44	States secretary of health and human services under 42 U.S.C.
45	45	Section 300gg-15; or
46	46	(2) the issuer is required to provide a disclosure
47	47	form for the plan or arrangement under Section 1509.002.
48	48	Sec. 1223.004. RULES. The commissioner may adopt rules
49	49	necessary to implement this chapter.
50	50	SUBCHAPTER B. DISCLOSURE REQUIRED
51	51	Sec. 1223.051. DISCLOSURE FORM TEMPLATE. (a) The
52	52	commissioner by rule shall prescribe a disclosure form template for
53	53	each type of health benefit plan or health expense arrangement to
54	54	which this chapter applies.
55	55	(b) The commissioner shall ensure that the disclosure form
56	56	template is presented in plain language and in a standardized
57	57	format designed to facilitate consumer understanding.
58	58	(c) The commissioner may prescribe as many disclosure form
59	59	templates as necessary to account for each type of health benefit
60	60	plan or health expense arrangement.
61	61	(d) Except as provided by Subsection (e), the disclosure
62	62	form template must include the following information that is
63	63	tailored to the type of health benefit plan or health expense
64	64	arrangement described by the template:
65	65	(1) a statement:
66	66	(A) of whether the plan or arrangement is
67	67	insurance; and
68	68	(B) of what, if any, guarantees are made of
69	69	payment for health care services;
70	70	(2) the duration of coverage;
71	71	(3) a statement:
72	72	(A) of whether:
73	73	(i) the plan or arrangement may be renewed
74	74	at the option of the enrollee or participant with no new
75	75	underwriting;
76	76	(ii) the plan or arrangement is only able to
77	77	be renewed at the option of the issuer after underwriting; or
78	78	(iii) the plan or arrangement may not be
79	79	renewed;
80	80	(B) of whether, on renewal, the issuer is able
81	81	to:
82	82	(i) increase the premium or assess a direct
83	83	fee, contribution, or similar cost; or
84	84	(ii) make changes to the plan or
85	85	arrangement terms, including benefits and limits, based on an
86	86	individual's health status;
87	87	(C) that the expiration of the plan or
88	88	arrangement is not a qualifying life event that would make a person
89	89	eligible for a special enrollment period, if applicable; and
90	90	(D) that the plan or arrangement may expire
91	91	outside of the open enrollment period under the Patient Protection
92	92	and Affordable Care Act (Pub. L. No. 111-148);
93	93	(4) to the extent the information is available, the
94	94	dates of the next three open enrollment periods under the Patient
95	95	Protection and Affordable Care Act (Pub. L. No. 111-148) following
96	96	the date the plan or arrangement expires;
97	97	(5) whether the plan or arrangement contains any
98	98	limitations or exclusions to preexisting conditions;
99	99	(6) the maximum dollar amount payable under the plan
100	100	or arrangement;
101	101	(7) the deductibles under the plan or arrangement and
102	102	the health care services to which the deductibles apply;
103	103	(8) whether the following health care services are
104	104	covered and any limits to the coverage:
105	105	(A) prescription drugs;
106	106	(B) mental health services;
107	107	(C) substance abuse treatment;
108	108	(D) maternity care;
109	109	(E) hospitalization;
110	110	(F) surgery;
111	111	(G) emergency health care; and
112	112	(H) preventive health care;
113	113	(9) for a plan or arrangement other than a
114	114	traditional, major medical health benefit plan, information on
115	115	unique aspects of the plan or arrangement and how it differs from
116	116	traditional, major medical coverage that the commissioner
117	117	determines is important to facilitate consumer understanding; and
118	118	(10) any other information the commissioner
119	119	determines is important for a purchaser of or participant in a plan
120	120	or arrangement.
121	121	(e) The commissioner may omit information described by
122	122	Subsection (d) in a disclosure form template if the information is
123	123	inapplicable to the type of plan or arrangement for which the
124	124	template is prescribed.
125	125	Sec. 1223.052. DISCLOSURE FORM REVIEW. (a) Before an
126	126	issuer may sell, market, or provide a health benefit plan or health
127	127	expense arrangement to a consumer, the issuer shall submit to the
128	128	department for approval in the manner prescribed by commissioner
129	129	rule a disclosure form for each plan or arrangement offered by the
130	130	issuer.
131	131	(b) Except as provided by Subsection (c), the disclosure
132	132	form must use the disclosure form template prescribed by the
133	133	commissioner under Section 1223.051 for the health benefit plan or
134	134	health expense arrangement described by the form.
135	135	(c) An issuer may modify the disclosure form template for a
136	136	health benefit plan or health expense arrangement that is not able
137	137	to be accurately represented by the template. If the issuer
138	138	modifies the template, the issuer shall clearly identify any
139	139	changes made and explain the reason for those changes when the
140	140	issuer submits the form for approval under Subsection (a).
141	141	(d) The department shall approve a disclosure form if the
142	142	form uses the appropriate disclosure form template and accurately
143	143	describes the health benefit plan or health expense arrangement in
144	144	a manner that is easily understandable to a consumer.
145	145	Sec. 1223.053. DISCLOSURE TO CONSUMER. (a) An issuer shall
146	146	provide to a consumer the disclosure form approved under Section
147	147	1223.052:
148	148	(1) before the earliest of the time that the consumer
149	149	completes an application, makes an initial premium payment, or
150	150	makes any other payment in connection with coverage under or
151	151	participation in the health benefit plan or health expense
152	152	arrangement; and
153	153	(2) at the time the policy, certificate, or
154	154	arrangement is issued or entered into.
155	155	(b) An issuer shall ensure that a consumer signs the
156	156	disclosure form before the issuer accepts an application or
157	157	payment for or issues or enters into the health benefit plan or
158	158	health expense arrangement. An electronic signature must comply
159	159	with Chapter 35 and rules adopted under this chapter.
160	160	Sec. 1223.054. RETENTION. An issuer shall retain a signed
161	161	disclosure form until the fifth anniversary of the date the issuer
162	162	receives the form, and the issuer shall make the form available to
163	163	the department on request.
164	164	Sec. 1223.055. HEALTH CARE SHARING MINISTRIES. The
165	165	commissioner shall consult with the attorney general in prescribing
166	166	the disclosure form template applicable to a health care sharing
167	167	ministry, and the template must incorporate the notice described by
168	168	Section 1681.002.
169	169	Sec. 1223.056. DIRECT PRIMARY CARE ARRANGEMENTS. The
170	170	commissioner shall consult with the Texas Medical Board in
171	171	prescribing the disclosure form template applicable to a direct
172	172	primary care arrangement, and the template must incorporate the
173	173	disclosure required by Section 162.256, Occupations Code.
174	174	Sec. 1223.057. ENFORCEMENT. The department may take an
175	175	enforcement action under Subtitle B, Title 2, against an issuer
176	176	that violates this chapter.
177	177	SECTION 2. Not later than January 1, 2024, the commissioner
178	178	of insurance shall adopt rules necessary to implement Chapter 1223,
179	179	Insurance Code, as added by this Act.
180	180	SECTION 3. Chapter 1223, Insurance Code, as added by this
181	181	Act, applies only to a health benefit plan or health expense
182	182	arrangement delivered, issued for delivery, entered into, or
183	183	renewed on or after January 1, 2024.
184	184	SECTION 4. This Act takes effect September 1, 2023.