Bill Text: TX HB2761 | 2021-2022 | 87th Legislature | Comm Sub
Bill Title: Relating to disclosure requirements for accident and health coverage and health expense arrangements marketed to individuals.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-04-26 - Committee report sent to Calendars [HB2761 Detail]
Download: Texas-2021-HB2761-Comm_Sub.html
87R18195 SMT-D | |||
By: Israel | H.B. No. 2761 | ||
Substitute the following for H.B. No. 2761: | |||
By: Oliverson | C.S.H.B. No. 2761 |
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relating to disclosure requirements for accident and health | ||
coverage and health expense arrangements marketed to individuals. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended | ||
by adding Chapter 1223 to read as follows: | ||
CHAPTER 1223. MANDATORY DISCLOSURES FOR ALTERNATIVE HEALTH | ||
COVERAGE AND HEALTH EXPENSE ARRANGEMENTS | ||
SUBCHAPTER A. GENERAL PROVISIONS | ||
Sec. 1223.001. DEFINITION. In this chapter, "issuer" means | ||
a person who markets, sells, issues, or operates an individual | ||
health benefit plan or health expense arrangement governed by this | ||
chapter. | ||
Sec. 1223.002. APPLICABILITY. (a) Except as provided by | ||
Subsection (b) or Section 1223.003 but notwithstanding any other | ||
law, this chapter applies to a health benefit plan or health expense | ||
arrangement marketed to an individual to provide health benefit | ||
coverage or pay for health care expenses, including: | ||
(1) a health care sharing ministry operated under | ||
Chapter 1681; | ||
(2) a discount health care program governed by Chapter | ||
7001; | ||
(3) a direct primary care arrangement governed by | ||
Subchapter F, Chapter 162, Occupations Code, but only if sold or | ||
marketed by a person other than a physician contracting directly | ||
with a patient; or | ||
(4) any other plan or arrangement the commissioner | ||
determines is or could be marketed to an individual as an | ||
alternative to major medical coverage. | ||
(b) Except as provided by Section 1223.003 and | ||
notwithstanding any other law, this chapter applies to an | ||
individual accident and health insurance policy governed by Chapter | ||
1201 or a group accident and health insurance policy governed by | ||
Chapter 1251 and marketed to an individual if the policy is a fixed | ||
indemnity, specified disease, or medical indemnity policy and: | ||
(1) the policy is marketed by the insurer or a third | ||
party as an alternative to major medical coverage; or | ||
(2) the policy: | ||
(A) has a range of benefits that is similar to the | ||
range of benefits in major medical coverage; and | ||
(B) may be sold as stand-alone coverage because | ||
the issuer does not require a purchaser to be covered by major | ||
medical coverage. | ||
Sec. 1223.003. EXCEPTION. This chapter does not apply to a | ||
health benefit plan or health expense arrangement if: | ||
(1) the issuer is required to submit a summary of | ||
benefits and coverage for the plan or arrangement to the United | ||
States secretary of health and human services under 42 U.S.C. | ||
Section 300gg-15; or | ||
(2) the issuer is required to provide a disclosure | ||
form for the plan or arrangement under Section 1509.002. | ||
Sec. 1223.004. RULES. The commissioner may adopt rules | ||
necessary to implement this chapter. Section 2001.0045, Government | ||
Code, does not apply to rules adopted under this section. | ||
SUBCHAPTER B. DISCLOSURE REQUIRED | ||
Sec. 1223.051. DISCLOSURE FORM TEMPLATE. (a) The | ||
commissioner by rule shall prescribe a disclosure form template for | ||
each type of health benefit plan or health expense arrangement to | ||
which this chapter applies. | ||
(b) The commissioner shall ensure that the disclosure form | ||
template is presented in plain language and in a standardized | ||
format designed to facilitate consumer understanding. | ||
(c) The commissioner may prescribe as many disclosure form | ||
templates as necessary to account for each type of health benefit | ||
plan or health expense arrangement. | ||
(d) The disclosure form template may include the following | ||
information, if applicable, that is tailored to the type of health | ||
benefit plan or health expense arrangement described by the | ||
template: | ||
(1) a statement: | ||
(A) of whether the plan or arrangement is | ||
insurance; and | ||
(B) of what, if any, guarantees are made of | ||
payment for or related to health care services; | ||
(2) the duration of the coverage or the arrangement; | ||
(3) if the plan or arrangement is subject to renewal, a | ||
statement: | ||
(A) of whether: | ||
(i) the plan or arrangement may be renewed | ||
at the option of the enrollee or participant with no new | ||
underwriting; | ||
(ii) the plan or arrangement is only able to | ||
be renewed at the option of the issuer after underwriting; or | ||
(iii) the plan or arrangement may not be | ||
renewed; and | ||
(B) of whether, on renewal, the issuer is able | ||
to: | ||
(i) increase the premium or assess a direct | ||
fee, contribution, or similar cost; or | ||
(ii) make changes to the plan or | ||
arrangement terms, including benefits and limits, based on an | ||
individual's health status; | ||
(4) a statement that the expiration of the plan or | ||
arrangement is not a qualifying life event that would make a person | ||
eligible for a special enrollment period, if applicable; | ||
(5) a statement that the plan or arrangement may | ||
expire outside of the open enrollment period under the Patient | ||
Protection and Affordable Care Act (Pub. L. No. 111-148); | ||
(6) to the extent the information is available, the | ||
dates of the next three open enrollment periods under the Patient | ||
Protection and Affordable Care Act (Pub. L. No. 111-148); | ||
(7) whether the plan or arrangement contains any | ||
limitations or exclusions to preexisting conditions; | ||
(8) the maximum dollar amount payable or shareable | ||
under the plan or arrangement; | ||
(9) the primary cost-sharing features under the plan | ||
or arrangement, including a deductible or amount that is not | ||
shareable, and the health care services to which the cost-sharing | ||
features apply; | ||
(10) whether the following health care services are | ||
covered or shareable and any limits relevant to that coverage or | ||
shareability: | ||
(A) prescription drugs; | ||
(B) mental health services; | ||
(C) substance abuse treatment; | ||
(D) maternity care; | ||
(E) hospitalization; | ||
(F) surgery; | ||
(G) emergency health care; and | ||
(H) preventive health care; | ||
(11) for a plan or arrangement other than a | ||
traditional, major medical health benefit plan, information on | ||
unique aspects of the plan or arrangement and how it differs from | ||
traditional, major medical coverage that the commissioner | ||
determines is important to facilitate consumer understanding; and | ||
(12) any other information the commissioner | ||
determines is important for a purchaser or participant of a plan or | ||
arrangement. | ||
(e) The commissioner may omit information described by | ||
Subsection (d) in a disclosure form template if the information is | ||
inapplicable to the type of plan or arrangement for which the | ||
template is prescribed. | ||
(f) The department shall incorporate the content for an | ||
outline of coverage required by Section 1201.108 into the | ||
disclosure form template for a policy to which that section | ||
applies. | ||
Sec. 1223.052. DISCLOSURE FORM REVIEW. (a) Before an | ||
issuer may sell, market, or provide an insurance product that is | ||
subject to a determination by the commissioner under Section | ||
1223.002(a)(4) or that is described by Section 1223.002(b), the | ||
issuer shall submit to the department for approval in the manner | ||
prescribed by commissioner rule a disclosure form on the product. | ||
(b) Except as provided by Subsection (a), an issuer | ||
providing a health benefit plan or health expense arrangement | ||
described by Section 1223.002(a) to a consumer shall submit to the | ||
department for informational purposes in the manner prescribed by | ||
commissioner rule a disclosure form for each plan or arrangement | ||
offered by the issuer. | ||
(c) Except as provided by Subsection (d), the disclosure | ||
form must use the disclosure form template prescribed by the | ||
commissioner under Section 1223.051 for the health benefit plan or | ||
health expense arrangement described by the form. | ||
(d) An issuer may modify the disclosure form template for a | ||
health benefit plan or health expense arrangement that is not able | ||
to be accurately represented by the template. If the issuer | ||
modifies the template, the issuer shall clearly identify any | ||
changes made and explain the reason for those changes when the | ||
issuer submits the form under Subsection (a) or (b). | ||
(e) The department shall approve a disclosure form | ||
submitted under Subsection (a) if the form uses the appropriate | ||
disclosure form template and accurately describes the health | ||
benefit plan or health expense arrangement in a manner that is | ||
easily understandable to a consumer. | ||
Sec. 1223.053. DISCLOSURE TO CONSUMER. (a) An issuer shall | ||
provide to a consumer the disclosure form submitted under Section | ||
1223.052 along with an application, if applicable: | ||
(1) before the earliest of the time that the consumer | ||
completes an application, makes an initial premium payment, or | ||
makes any other payment in connection with coverage under or | ||
participation in the health benefit plan or health expense | ||
arrangement; and | ||
(2) at the time the policy, certificate, or | ||
arrangement is issued or entered into. | ||
(b) An issuer shall ensure that a consumer signs the | ||
disclosure form before the issuer accepts an application or | ||
payment for or issues or enters into the health benefit plan or | ||
health expense arrangement. An electronic signature must comply | ||
with Chapter 35 and rules adopted under this chapter. | ||
Sec. 1223.054. RETENTION. An issuer shall retain a signed | ||
disclosure form until the fifth anniversary of the date the issuer | ||
receives the form, and the issuer shall make the form available to | ||
the department on request. | ||
Sec. 1223.055. HEALTH CARE SHARING MINISTRIES. The | ||
commissioner shall consult with the attorney general in prescribing | ||
the disclosure form template applicable to a health care sharing | ||
ministry, and the template must incorporate the notice described by | ||
Section 1681.002. | ||
Sec. 1223.056. DIRECT PRIMARY CARE ARRANGEMENTS. The | ||
commissioner shall consult with the Texas Medical Board in | ||
prescribing the disclosure form template applicable to a direct | ||
primary care arrangement, and the template must incorporate the | ||
disclosure required by Section 162.256, Occupations Code. | ||
Sec. 1223.057. ENFORCEMENT. The department may take an | ||
enforcement action under Subtitle B, Title 2, against an issuer | ||
that violates this chapter. | ||
SECTION 2. Not later than September 1, 2022, the | ||
commissioner of insurance shall adopt rules necessary to implement | ||
Chapter 1223, Insurance Code, as added by this Act. | ||
SECTION 3. Chapter 1223, Insurance Code, as added by this | ||
Act, applies only to a health benefit plan or health expense | ||
arrangement delivered, issued for delivery, entered into, or | ||
renewed on or after September 1, 2022. | ||
SECTION 4. This Act takes effect September 1, 2021. |