| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
| |
|
|
relating to multiple employer welfare arrangements. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Subchapter A, Chapter 846, Insurance Code, is |
|
|
amended by adding Section 846.0035 to read as follows: |
|
|
Sec. 846.0035. APPLICABILITY OF CERTAIN LAWS TO ASSOCIATION |
|
|
PROVIDING HEALTH BENEFITS. (a) This section applies only to a |
|
|
multiple employer welfare arrangement: |
|
|
(1) that was issued an initial certificate of |
|
|
authority under Section 846.054 on or after January 1, 2022; or |
|
|
(2) that elects to be bound by this section in the |
|
|
manner prescribed by the commissioner. |
|
|
(b) A multiple employer welfare arrangement that provides a |
|
|
comprehensive health benefit plan, as determined by the |
|
|
commissioner, is subject to the following laws as if the |
|
|
arrangement were an insurer, individuals entitled to coverage under |
|
|
the plan were insureds, and the health benefits were provided |
|
|
through an insurance policy: |
|
|
(1) Chapter 421; |
|
|
(2) Chapter 422; |
|
|
(3) Subchapters C, F, and K, Chapter 1451; and |
|
|
(4) Chapter 4201. |
|
|
(c) A multiple employer welfare arrangement that provides a |
|
|
comprehensive health benefit plan, as determined by the |
|
|
commissioner, that is determined by the commissioner to be |
|
|
structured in the manner of a preferred provider benefit plan or an |
|
|
exclusive provider benefit plan as defined in Section 1301.001 is |
|
|
subject to the following laws as if the arrangement were an insurer, |
|
|
individuals entitled to coverage under the plan were insureds, and |
|
|
the health benefits were provided through an insurance policy: |
|
|
(1) Chapter 1301; and |
|
|
(2) Chapter 1467. |
|
|
SECTION 2. Section 846.052(b), Insurance Code, is amended |
|
|
to read as follows: |
|
|
(b) The application form must be completed and submitted |
|
|
along with all information required by the commissioner, including: |
|
|
(1) a copy of each organizational document; |
|
|
(2) current financial statements of the arrangement; |
|
|
(3) a fully detailed statement indicating the plan |
|
|
under which the arrangement proposes to transact business; |
|
|
(4) an initial actuarial opinion in compliance with |
|
|
the requirements of Section 846.153(a)(2) and subject to Section |
|
|
846.157(b); and |
|
|
(5) demonstration [a statement] by the applicant |
|
|
[certifying] that the arrangement is in compliance with all |
|
|
applicable federal and state laws [provisions of the Employee |
|
|
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
|
|
seq.)]. |
|
|
SECTION 3. Section 846.053, Insurance Code, is amended by |
|
|
amending Subsections (b) and (c) and adding Subsection (d-1) to |
|
|
read as follows: |
|
|
(b) The employers in the multiple employer welfare |
|
|
arrangement must: |
|
|
(1) be members of an association or group of five or |
|
|
more businesses that are in the same trade or industry, including |
|
|
closely related businesses that provide support, services, or |
|
|
supplies primarily to that trade or industry; or |
|
|
(2) for a multiple employer welfare arrangement to |
|
|
which Section 846.0035 applies, each have a principal place of |
|
|
business in the same region that does not exceed the boundaries of |
|
|
this state or the boundaries of a metropolitan statistical area |
|
|
designated by the United States Office of Management and Budget. |
|
|
(c) If the employers in the multiple employer welfare |
|
|
arrangement are members of an association, the association must: |
|
|
(1) be engaged in substantial activity for its |
|
|
members other than sponsorship of an employee welfare benefit plan; |
|
|
and |
|
|
(2) if Section 846.0035 does not apply to the multiple |
|
|
employer welfare arrangement, have been in existence for at least |
|
|
two years before engaging in any activities relating to providing |
|
|
employee health benefits to its members. |
|
|
(d-1) For purposes of a multiple employer welfare |
|
|
arrangement to which Section 846.0035 applies, a working owner of a |
|
|
trade or business without employees may qualify as both an employer |
|
|
and as an employee of the trade or industry for the purposes of this |
|
|
section. In this subsection, "working owner" means an individual |
|
|
who: |
|
|
(1) has an ownership right of any nature in a trade or |
|
|
business, whether incorporated or unincorporated, including a |
|
|
partner and other self-employed individual; |
|
|
(2) earns wages or self-employment income from the |
|
|
trade or business for providing personal services to the trade or |
|
|
business; and |
|
|
(3) either: |
|
|
(A) works on average at least 20 hours per week or |
|
|
at least 80 hours per month providing personal services to the |
|
|
working owner's trade or business; or |
|
|
(B) has wages or self-employment income from the |
|
|
individual's trade or business that at least equals the |
|
|
individual's cost of coverage for participation by the individual |
|
|
and any covered beneficiaries in the group health plan sponsored by |
|
|
the group or association in which the individual is participating. |
|
|
SECTION 4. This Act takes effect September 1, 2021. |
|
|
|
|
|
* * * * * |