Bill Text: TX SB1087 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to the creation of a health insurance risk pool for certain health benefit plan enrollees; authorizing an assessment.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-07 - Referred to Business & Commerce [SB1087 Detail]
Download: Texas-2019-SB1087-Introduced.html
86R12955 PMO-F | ||
By: Johnson | S.B. No. 1087 |
|
||
|
||
relating to the creation of a health insurance risk pool for certain | ||
health benefit plan enrollees; authorizing an assessment. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle G, Title 8, Insurance Code, is amended | ||
by adding Chapter 1511 to read as follows: | ||
CHAPTER 1511. HEALTH INSURANCE RISK POOL | ||
Sec. 1511.001. DEFINITION. In this chapter, "pool" means a | ||
health insurance risk pool established and administered by the | ||
commissioner under this chapter. | ||
Sec. 1511.002. ESTABLISHMENT OF HEALTH INSURANCE RISK POOL. | ||
To the extent that federal funds are available, the commissioner | ||
may: | ||
(1) apply for the federal funds; and | ||
(2) use the federal funds to establish and administer | ||
a pool for the purpose of this chapter. | ||
Sec. 1511.003. PURPOSE OF POOL. (a) The purpose of the | ||
pool is to provide a mechanism to meaningfully reduce health | ||
insurance premiums in the individual health insurance market by | ||
maximizing available federal funds to assist residents of this | ||
state to obtain guaranteed issue health benefit coverage. | ||
(b) The pool may not be used to expand the Medicaid program, | ||
including the program administered under Chapter 32, Human | ||
Resources Code, and the program administered under Chapter 533, | ||
Government Code. | ||
Sec. 1511.004. METHODS TO REDUCE PREMIUM IN THE INDIVIDUAL | ||
MARKET. Subject to any requirements to obtain federal funds for the | ||
pool, the commissioner may use money from the pool to achieve lower | ||
enrollee premium rates by providing to health benefit plan issuers | ||
writing guaranteed issue coverage in the individual market: | ||
(1) a reinsurance program; or | ||
(2) direct funding if the health benefit plan issuer's | ||
plan provides coverage for individuals described by Section | ||
1511.005. | ||
Sec. 1511.005. ACCESS TO GUARANTEED ISSUE COVERAGE. The | ||
commissioner shall use pool funds to enhance enrollment in | ||
guaranteed issue coverage in the individual market in a manner that | ||
ensures that the benefits and cost-sharing protections available in | ||
the individual market are maintained in the same manner the | ||
benefits and protections would be maintained without the waiver | ||
described by Section 1511.020. | ||
Sec. 1511.006. CONTRACTS AND AGREEMENTS. The commissioner | ||
may enter into a contract or agreement that the commissioner | ||
determines is appropriate to carry out this chapter, including a | ||
contract or agreement with: | ||
(1) a similar pool in another state for the joint | ||
performance of common administrative functions; | ||
(2) another organization for the performance of | ||
administrative functions; or | ||
(3) a federal agency. | ||
Sec. 1511.007. FUNDING. (a) The commissioner may use funds | ||
appropriated to the department to: | ||
(1) apply for federal funds and grants; and | ||
(2) administer this chapter. | ||
(b) Notwithstanding Section 6(e)(2)(B), Chapter 615 (S.B. | ||
1367), Acts of the 83rd Legislature, Regular Session, 2013, the | ||
commissioner may use money appropriated to the department from the | ||
healthy Texas small employer premium stabilization fund for the | ||
exclusive purposes of this chapter, other than for paying salaries | ||
and salary-related benefits. | ||
(c) Notwithstanding Section 6(e)(2)(B), Chapter 615 (S.B. | ||
1367), Acts of the 83rd Legislature, Regular Session, 2013, the | ||
commissioner shall transfer money from the healthy Texas small | ||
employer premium stabilization fund to the Texas Department of | ||
Insurance operating account in an amount equal to the amount of | ||
money appropriated to the department from that fund, as described | ||
by Subsection (b), for the direct and indirect costs of the | ||
exclusive purposes of this chapter. | ||
(d) Except as provided by Subsections (a) and (b), the | ||
commissioner may not use any state funds to fund the pool unless the | ||
funds are specifically appropriated for that purpose. | ||
Sec. 1511.008. ASSESSMENTS. (a) The commissioner may | ||
assess health benefit plan issuers, including making advance | ||
interim assessments, as reasonable and necessary for the pool's | ||
organizational and interim operating expenses. | ||
(b) The commissioner shall credit an interim assessment as | ||
an offset against any regular assessment that is due after the end | ||
of the fiscal year. | ||
(c) The regular assessment is the amount determined by the | ||
commissioner under Section 1511.009 and recovered from health | ||
benefit plan issuers under Section 1511.013. | ||
Sec. 1511.009. DETERMINATION OF POOL FUNDING REQUIREMENTS. | ||
After the end of each fiscal year, the commissioner shall determine | ||
for the next calendar year the amount of money required by the pool | ||
to reduce the amount of premiums the enrollee would otherwise pay in | ||
that year by 15 percent in accordance with this chapter after | ||
applying the federal funds obtained under this chapter. | ||
Sec. 1511.010. ANNUAL REPORT TO COMMISSIONER. Each health | ||
benefit plan issuer shall report to the commissioner the | ||
information requested by the commissioner, as of December 31 of the | ||
preceding year. | ||
Sec. 1511.011. ANNUAL REPORT TO COMMISSIONER: ENROLLED | ||
INDIVIDUALS. (a) Each health benefit plan issuer shall report to | ||
the commissioner the number of residents of this state enrolled, as | ||
of December 31 of the previous year, in the issuer's health benefit | ||
plans providing coverage for residents in this state, as: | ||
(1) an employee under a group health benefit plan; or | ||
(2) an individual policyholder or subscriber. | ||
(b) In determining the number of individuals to report under | ||
Subsection (a)(1), the health benefit plan issuer shall include | ||
each employee for whom a premium is paid and coverage is provided | ||
under an excess loss, stop-loss, or reinsurance policy issued by | ||
the issuer to an employer or group health benefit plan providing | ||
coverage for employees in this state. A health benefit plan issuer | ||
providing excess loss insurance, stop-loss insurance, or | ||
reinsurance, as described by this subsection, for a primary health | ||
benefit plan issuer may not report individuals reported by the | ||
primary health benefit plan issuer. | ||
(c) Ten employees covered by a health plan issuer under a | ||
policy of excess loss insurance, stop-loss insurance, or | ||
reinsurance count as one employee for purposes of determining that | ||
health plan issuer's assessment. | ||
(d) In determining the number of individuals to report under | ||
this section, the health benefit plan issuer shall exclude: | ||
(1) the dependents of the employee or an individual | ||
policyholder or subscriber; and | ||
(2) individuals who are covered by the health benefit | ||
plan issuer under a Medicare supplement benefit plan subject to | ||
Chapter 1652. | ||
(e) In determining the number of enrolled individuals to | ||
report under this section, the health benefit plan issuer shall | ||
exclude individuals who are retired employees 65 years of age or | ||
older. | ||
Sec. 1511.012. ANNUAL REPORT TO COMMISSIONER: GROSS | ||
PREMIUMS. (a) Each health benefit plan issuer shall report to the | ||
commissioner the gross premiums collected for the preceding | ||
calendar year for health benefit plans. | ||
(b) For purposes of this section, gross health benefit plan | ||
premiums do not include premiums collected for: | ||
(1) coverage under a Medicare supplement benefit plan | ||
subject to Chapter 1652; | ||
(2) coverage under a small employer health benefit | ||
plan subject to Chapter 1501; | ||
(3) coverage: | ||
(A) for wages or payments in lieu of wages for a | ||
period during which an employee is absent from work because of | ||
accident or disability; | ||
(B) as a supplement to a liability insurance | ||
policy; | ||
(C) for credit insurance; | ||
(D) only for dental or vision care; | ||
(E) only for a specified disease or illness; or | ||
(F) only for indemnity for hospital confinement; | ||
(4) a workers' compensation insurance policy; | ||
(5) medical payment insurance coverage provided under | ||
a motor vehicle insurance policy; | ||
(6) a long-term care policy, including a nursing home | ||
fixed indemnity policy, unless the commissioner determines that the | ||
policy provides comprehensive health benefit plan coverage; | ||
(7) liability insurance coverage, including general | ||
liability insurance and automobile liability insurance; | ||
(8) coverage for on-site medical clinics; | ||
(9) insurance coverage under which benefits are | ||
payable with or without regard to fault and that is statutorily | ||
required to be contained in a liability insurance policy or | ||
equivalent self-insurance; or | ||
(10) other similar insurance coverage, as specified by | ||
federal regulations issued under the Health Insurance Portability | ||
and Accountability Act of 1996 (Pub. L. No. 104-191), under which | ||
benefits for medical care are secondary or incidental to other | ||
insurance benefits. | ||
Sec. 1511.013. ASSESSMENTS TO COVER POOL FUNDING | ||
REQUIREMENTS. (a) The commissioner shall recover an amount equal | ||
to the funding required as estimated under Section 1511.009 by | ||
assessing each health benefit plan issuer an amount determined | ||
annually by the commissioner based on information in annual | ||
statements, the health benefit plan issuer's annual report to the | ||
commissioner under Sections 1511.010 and 1511.011, and any other | ||
reports required by and filed with the commissioner. | ||
(b) The commissioner shall use the total number of enrolled | ||
individuals reported by all health benefit plan issuers under | ||
Section 1511.011 as of the preceding December 31 to compute the | ||
amount of a health benefit plan issuer's assessment, if any, in | ||
accordance with this subsection. The commissioner shall allocate | ||
the total amount to be assessed based on the total number of | ||
enrolled individuals covered by excess loss, stop-loss, or | ||
reinsurance policies and on the total number of other enrolled | ||
individuals as determined under Section 1511.011. To compute the | ||
amount of a health benefit plan issuer's assessment: | ||
(1) for the issuer's enrolled individuals covered by | ||
an excess loss, stop-loss, or reinsurance policy, the commissioner | ||
shall: | ||
(A) divide the allocated amount to be assessed by | ||
the total number of enrolled individuals covered by excess loss, | ||
stop-loss, or reinsurance policies, as determined under Section | ||
1511.011, to determine the per capita amount; and | ||
(B) multiply the number of a health benefit plan | ||
issuer's enrolled individuals covered by an excess loss, stop-loss, | ||
or reinsurance policy, as determined under Section 1511.011, by the | ||
per capita amount to determine the amount assessed to that health | ||
benefit plan issuer; and | ||
(2) for the issuer's enrolled individuals not covered | ||
by excess loss, stop-loss, or reinsurance policies, the | ||
commissioner, using the gross health benefit plan premiums reported | ||
for the preceding calendar year by health benefit plan issuers | ||
under Section 1511.012, shall: | ||
(A) divide the gross premium collected by a | ||
health benefit plan issuer by the gross premium collected by all | ||
health benefit plan issuers; and | ||
(B) multiply the allocated amount to be assessed | ||
by the fraction computed under Paragraph (A) to determine the | ||
amount assessed to that health benefit plan issuer. | ||
(c) A small employer health benefit plan subject to Chapter | ||
1501 is not subject to an assessment under this section. | ||
Sec. 1511.014. ASSESSMENT DUE DATE; INTEREST. (a) An | ||
assessment is due on the date specified by the commissioner that is | ||
not earlier than the 30th day after the date written notice of the | ||
assessment is transmitted to the health benefit plan issuer. | ||
(b) Interest accrues on the unpaid amount of an assessment | ||
at a rate equal to the prime lending rate, as published in the most | ||
recent issue of the Wall Street Journal and determined as of the | ||
first day of each month during which the assessment is delinquent, | ||
plus three percent. | ||
Sec. 1511.015. ABATEMENT OR DEFERMENT OF ASSESSMENT. (a) A | ||
health benefit plan issuer may petition the commissioner for an | ||
abatement or deferment of all or part of an assessment imposed by | ||
the commissioner. The commissioner may abate or defer all or part | ||
of the assessment if the commissioner determines that payment of | ||
the assessment would endanger the ability of the health benefit | ||
plan issuer to fulfill its contractual obligations. | ||
(b) If all or part of an assessment against a health benefit | ||
plan issuer is abated or deferred, the amount of the abatement or | ||
deferment shall be assessed against the other health benefit plan | ||
issuers in a manner consistent with the method for computing | ||
assessments under this chapter. | ||
(c) A health benefit plan issuer receiving an abatement or | ||
deferment under this section remains liable to the pool for the | ||
deficiency. | ||
Sec. 1511.016. USE OF EXCESS FROM ASSESSMENTS. If the total | ||
amount of the assessments exceeds the pool's actual losses and | ||
administrative expenses, the commissioner shall credit each health | ||
benefit plan issuer with the excess in an amount proportionate to | ||
the amount the health benefit plan issuer paid in assessments. The | ||
credit may be paid to the health benefit plan issuer or applied to | ||
future assessments under this chapter. | ||
Sec. 1511.017. COLLECTION OF ASSESSMENTS. The pool may | ||
recover or collect assessments made under this chapter. | ||
Sec. 1511.018. PROCEDURES, CRITERIA, AND FORMS. The | ||
commissioner by rule shall provide the procedures, criteria, and | ||
forms necessary to implement, collect, and deposit assessments | ||
under this chapter. | ||
Sec. 1511.019. PUBLIC EDUCATION AND OUTREACH. (a) The | ||
commissioner may use funds appropriated to the department for the | ||
exclusive purposes of this chapter to develop and implement public | ||
education, outreach, and facilitated enrollment strategies under | ||
this chapter. | ||
(b) The commissioner may contract with marketing | ||
organizations to perform or provide assistance with the strategies | ||
described by Subsection (a). | ||
Sec. 1511.020. WAIVER. The commissioner may: | ||
(1) apply to the United States secretary of health and | ||
human services under 42 U.S.C. Section 18052 for a waiver of | ||
applicable provisions of the Patient Protection and Affordable Care | ||
Act (Pub. L. No. 111-148) and any applicable regulations or | ||
guidance; | ||
(2) take any action the commissioner considers | ||
appropriate to make an application under Subdivision (1); and | ||
(3) implement a state plan that meets the requirements | ||
of a waiver granted in response to an application under Subdivision | ||
(1) if the plan is: | ||
(A) consistent with state and federal law; and | ||
(B) approved by the United States secretary of | ||
health and human services. | ||
Sec. 1511.021. AUTHORITY TO ACT AS REINSURER. In addition | ||
to the powers granted to the commissioner under this chapter, the | ||
commissioner may exercise any authority that may be exercised under | ||
the law of this state by a reinsurer. | ||
Sec. 1511.022. RULES. The commissioner may adopt rules | ||
necessary to implement this chapter, including rules to administer | ||
the pool and distribute money from the pool. | ||
Sec. 1511.023. EXEMPTION FROM STATE TAXES AND FEES. | ||
Notwithstanding any other law, a program created under this chapter | ||
is not subject to any state tax, regulatory fee, or surcharge, | ||
including a premium or maintenance tax or fee. | ||
Sec. 1511.024. ANNUAL REPORT OF POOL ACTIVITIES. (a) | ||
Beginning June 1, 2020, not later than June 1 of each year, the | ||
department shall submit a report to the governor, the lieutenant | ||
governor, and the speaker of the house of representatives. | ||
(b) The report submitted under Subsection (a) must | ||
summarize the activities conducted under this chapter in the | ||
calendar year preceding the year in which the report is submitted. | ||
SECTION 2. Notwithstanding Section 6(d)(2), Chapter 615 | ||
(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013, | ||
on the effective date of this Act, the commissioner of insurance | ||
shall transfer any money remaining outside the state treasury in | ||
the Texas Treasury Safekeeping Trust Company account established | ||
under Section 6(c), Chapter 615 (S.B. 1367), Acts of the 83rd | ||
Legislature, Regular Session, 2013, to the health insurance risk | ||
pool established by Chapter 1511, Insurance Code, as added by this | ||
Act. | ||
SECTION 3. 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, 2019. |