Dean Bill Exempts Thinner Health Plans From Other Insurance Law

The text as introduced · 858 words

89R5875 SCR-F

By: Dean
H.B. No. 4009

A BILL TO BE ENTITLED

AN ACT

relating to employer health benefit plans that do not include

state-mandated health benefits.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle G, Title 8, Insurance Code, is amended

by adding Chapter 1506 to read as follows:

CHAPTER 1506. EMPLOYER CHOICE OF BENEFITS PLANS

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 1506.001. DEFINITIONS. In this chapter:

(1) "Employer choice of benefits plan" means a group

health benefit plan offered to an employer that, wholly or partly,

does not offer or provide state-mandated health benefits, but that

provides creditable coverage as defined by Section 1205.004(a) or

1501.102(a).

(2) "Health benefit plan issuer" means any entity

authorized under this code or another insurance law of this state to

provide health insurance or health benefits in this state. The term

includes an insurance company, a group hospital service corporation

operating under Chapter 842, a health maintenance organization

operating under Chapter 843, and a stipulated premium company

operating under Chapter 844.

(3) "State-mandated health benefits" means coverage

or another feature required under this code or other laws of this

state to be provided in a group health benefit plan that:

(A) includes coverage for specific health care

services or benefits;

(B) places limitations or restrictions on

deductibles, coinsurance, copayments, or any annual or lifetime

maximum benefit amounts, including limitations provided by

commissioner rule;

(C) includes a specific category of licensed

health care practitioner from whom an enrollee is entitled to

receive care;

(D) requires standard provisions or rights that

are unrelated to a specific health illness, injury, or condition of

an enrollee; or

(E) requires the health benefit plan to exceed

federal requirements.

Sec. 1506.002. RULES. The commissioner shall adopt rules

necessary to implement this chapter.

SUBCHAPTER B. EMPLOYER CHOICE OF BENEFITS PLANS

Sec. 1506.101. PLANS AUTHORIZED. (a) A health benefit plan

issuer may offer one or more employer choice of benefits plans.

(b) An employer choice of benefits plan must include

coverage for essential health benefits as defined by 42 C.F.R.

Section 440.347.

Sec. 1506.102. NOTICE TO ENROLLEES. (a) Each written

application to enroll in an employer choice of benefits plan must

contain the following language at the beginning of the document in

bold type:

"You have the option to enroll in this Employer Choice

of Benefits Plan that, either wholly or partly, does not provide

state-mandated health benefits normally required in health benefit

plans in Texas. This employer health benefit plan may provide a

more affordable health benefit plan for you, although, at the same

time, it may provide you with fewer health benefits than those

normally included as state-mandated health benefits in health

benefit plans in Texas. If you choose this employer health benefit

plan, please consult with your insurance agent to discover which

state-mandated health benefits are excluded from this health

benefit plan."

(b) Each employer choice of benefits plan must contain the

following language at the beginning of the document in bold type:

"This Employer Choice of Benefits Plan, either wholly

or partly, does not provide state-mandated health benefits normally

required in health benefit plans in Texas. This employer health

benefit plan may provide a more affordable health benefit plan for

you, although, at the same time, it may provide you with fewer

health benefits than those normally included as state-mandated

health benefits in health benefit plans in Texas. Please consult

with your insurance agent to discover which state-mandated health

benefits are excluded from this health benefit plan."

Sec. 1506.103. DISCLOSURE STATEMENT. (a) Before a health

benefit plan issuer may contract to provide an employer choice of

benefits plan to an employer, the issuer must provide the employer

with a written disclosure statement that:

(1) acknowledges that the employer health benefit plan

being contracted for does not provide some or all state-mandated

health benefits; and

(2) lists those state-mandated health benefits not

included in the plan.

(b) An employer entering into an initial contract for an

employer choice of benefits plan must sign the disclosure statement

provided by the health benefit plan issuer under Subsection (a) and

return the statement to the issuer.

(c) A health benefit plan issuer shall:

(1) retain the signed disclosure statement in the

health benefit plan issuer's records; and

(2) on request from the commissioner, provide the

signed disclosure statement to the department.

Sec. 1506.104. ADDITIONAL HEALTH BENEFIT PLANS. A health

benefit plan issuer that offers one or more employer choice of

benefits plans must also offer employers at least one group health

benefit plan that provides state-mandated health benefits and is

otherwise authorized by this code.

Sec. 1506.105. COVERAGE EXEMPT FROM INSURANCE LAW. An

employer choice of benefits plan provided under this chapter is

exempt from any other insurance law, including common law, that

does not expressly apply to the plan or this chapter.

SECTION 2. This Act takes effect immediately if it receives

a vote of two-thirds of all the members elected to each house, as

provided by Section 39, Article III, Texas Constitution. If this

Act does not receive the vote necessary for immediate effect, this

Act takes effect September 1, 2025.