Texas 2025 - 89th Regular

Texas House Bill HB4009 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	89R5875 SCR-F
2	2	By: Dean H.B. No. 4009
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to employer health benefit plans that do not include
10	10	state-mandated health benefits.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
13	13	by adding Chapter 1506 to read as follows:
14	14	CHAPTER 1506. EMPLOYER CHOICE OF BENEFITS PLANS
15	15	SUBCHAPTER A. GENERAL PROVISIONS
16	16	Sec. 1506.001. DEFINITIONS. In this chapter:
17	17	(1) "Employer choice of benefits plan" means a group
18	18	health benefit plan offered to an employer that, wholly or partly,
19	19	does not offer or provide state-mandated health benefits, but that
20	20	provides creditable coverage as defined by Section 1205.004(a) or
21	21	1501.102(a).
22	22	(2) "Health benefit plan issuer" means any entity
23	23	authorized under this code or another insurance law of this state to
24	24	provide health insurance or health benefits in this state. The term
25	25	includes an insurance company, a group hospital service corporation
26	26	operating under Chapter 842, a health maintenance organization
27	27	operating under Chapter 843, and a stipulated premium company
28	28	operating under Chapter 844.
29	29	(3) "State-mandated health benefits" means coverage
30	30	or another feature required under this code or other laws of this
31	31	state to be provided in a group health benefit plan that:
32	32	(A) includes coverage for specific health care
33	33	services or benefits;
34	34	(B) places limitations or restrictions on
35	35	deductibles, coinsurance, copayments, or any annual or lifetime
36	36	maximum benefit amounts, including limitations provided by
37	37	commissioner rule;
38	38	(C) includes a specific category of licensed
39	39	health care practitioner from whom an enrollee is entitled to
40	40	receive care;
41	41	(D) requires standard provisions or rights that
42	42	are unrelated to a specific health illness, injury, or condition of
43	43	an enrollee; or
44	44	(E) requires the health benefit plan to exceed
45	45	federal requirements.
46	46	Sec. 1506.002. RULES. The commissioner shall adopt rules
47	47	necessary to implement this chapter.
48	48	SUBCHAPTER B. EMPLOYER CHOICE OF BENEFITS PLANS
49	49	Sec. 1506.101. PLANS AUTHORIZED. (a) A health benefit plan
50	50	issuer may offer one or more employer choice of benefits plans.
51	51	(b) An employer choice of benefits plan must include
52	52	coverage for essential health benefits as defined by 42 C.F.R.
53	53	Section 440.347.
54	54	Sec. 1506.102. NOTICE TO ENROLLEES. (a) Each written
55	55	application to enroll in an employer choice of benefits plan must
56	56	contain the following language at the beginning of the document in
57	57	bold type:
58	58	"You have the option to enroll in this Employer Choice
59	59	of Benefits Plan that, either wholly or partly, does not provide
60	60	state-mandated health benefits normally required in health benefit
61	61	plans in Texas. This employer health benefit plan may provide a
62	62	more affordable health benefit plan for you, although, at the same
63	63	time, it may provide you with fewer health benefits than those
64	64	normally included as state-mandated health benefits in health
65	65	benefit plans in Texas. If you choose this employer health benefit
66	66	plan, please consult with your insurance agent to discover which
67	67	state-mandated health benefits are excluded from this health
68	68	benefit plan."
69	69	(b) Each employer choice of benefits plan must contain the
70	70	following language at the beginning of the document in bold type:
71	71	"This Employer Choice of Benefits Plan, either wholly
72	72	or partly, does not provide state-mandated health benefits normally
73	73	required in health benefit plans in Texas. This employer health
74	74	benefit plan may provide a more affordable health benefit plan for
75	75	you, although, at the same time, it may provide you with fewer
76	76	health benefits than those normally included as state-mandated
77	77	health benefits in health benefit plans in Texas. Please consult
78	78	with your insurance agent to discover which state-mandated health
79	79	benefits are excluded from this health benefit plan."
80	80	Sec. 1506.103. DISCLOSURE STATEMENT. (a) Before a health
81	81	benefit plan issuer may contract to provide an employer choice of
82	82	benefits plan to an employer, the issuer must provide the employer
83	83	with a written disclosure statement that:
84	84	(1) acknowledges that the employer health benefit plan
85	85	being contracted for does not provide some or all state-mandated
86	86	health benefits; and
87	87	(2) lists those state-mandated health benefits not
88	88	included in the plan.
89	89	(b) An employer entering into an initial contract for an
90	90	employer choice of benefits plan must sign the disclosure statement
91	91	provided by the health benefit plan issuer under Subsection (a) and
92	92	return the statement to the issuer.
93	93	(c) A health benefit plan issuer shall:
94	94	(1) retain the signed disclosure statement in the
95	95	health benefit plan issuer's records; and
96	96	(2) on request from the commissioner, provide the
97	97	signed disclosure statement to the department.
98	98	Sec. 1506.104. ADDITIONAL HEALTH BENEFIT PLANS. A health
99	99	benefit plan issuer that offers one or more employer choice of
100	100	benefits plans must also offer employers at least one group health
101	101	benefit plan that provides state-mandated health benefits and is
102	102	otherwise authorized by this code.
103	103	Sec. 1506.105. COVERAGE EXEMPT FROM INSURANCE LAW. An
104	104	employer choice of benefits plan provided under this chapter is
105	105	exempt from any other insurance law, including common law, that
106	106	does not expressly apply to the plan or this chapter.
107	107	SECTION 2. This Act takes effect immediately if it receives
108	108	a vote of two-thirds of all the members elected to each house, as
109	109	provided by Section 39, Article III, Texas Constitution. If this
110	110	Act does not receive the vote necessary for immediate effect, this
111	111	Act takes effect September 1, 2025.