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COMMITTEE VOTE |
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YeaNayAbsentPNV |
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KolkhorstX |
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PerryX |
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BlancoX |
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HallX |
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HancockX |
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HughesX |
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LaMantiaX |
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MilesX |
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SparksX |
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A BILL TO BE ENTITLED
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AN ACT
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relating to multiple employer welfare arrangements. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter A, Chapter 846, Insurance Code, is |
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amended by adding Section 846.0035 to read as follows: |
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Sec. 846.0035. APPLICABILITY OF CERTAIN LAWS TO ASSOCIATION |
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PROVIDING HEALTH BENEFITS. (a) This section applies only to a |
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multiple employer welfare arrangement: |
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(1) that was issued an initial certificate of |
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authority under Section 846.054 on or after January 1, 2024; or |
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(2) that elects to be bound by this section in the |
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manner prescribed by the commissioner. |
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(b) A multiple employer welfare arrangement that provides a |
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comprehensive health benefit plan, as determined by the |
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commissioner, is subject to the following laws as if the |
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arrangement were an insurer, individuals entitled to coverage under |
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the plan were insureds, and the health benefits were provided |
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through an insurance policy: |
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(1) Chapter 421; |
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(2) Chapter 422; |
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(3) Subchapters C, F, and K, Chapter 1451; and |
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(4) Chapter 4201. |
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(c) A multiple employer welfare arrangement that provides a |
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comprehensive health benefit plan, as determined by the |
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commissioner, that is determined by the commissioner to be |
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structured in the manner of a preferred provider benefit plan or an |
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exclusive provider benefit plan as defined in Section 1301.001 is |
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subject to the following laws as if the arrangement were an insurer, |
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individuals entitled to coverage under the plan were insureds, and |
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the health benefits were provided through an insurance policy: |
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(1) Chapter 1301; and |
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(2) Chapter 1467. |
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SECTION 2. Section 846.052(b), Insurance Code, is amended |
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to read as follows: |
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(b) The application form must be completed and submitted |
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along with all information required by the commissioner, including: |
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(1) a copy of each organizational document; |
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(2) current financial statements of the arrangement; |
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(3) a fully detailed statement indicating the plan |
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under which the arrangement proposes to transact business; |
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(4) an initial actuarial opinion in compliance with |
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the requirements of Section 846.153(a)(2) and subject to Section |
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846.157(b); and |
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(5) demonstration [a statement] by the applicant |
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[certifying] that the arrangement is in compliance with all |
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applicable federal and state laws, as determined by the |
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commissioner [provisions of the Employee Retirement Income |
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Security Act of 1974 (29 U.S.C. Section 1001 et seq.)]. |
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SECTION 3. Section 846.053, Insurance Code, is amended by |
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amending Subsections (b) and (c) and adding Subsection (d-1) to |
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read as follows: |
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(b) The employers in the multiple employer welfare |
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arrangement must: |
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(1) be members of an association or group of five or |
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more businesses that are in the same trade or industry, including |
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closely related businesses that provide support, services, or |
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supplies primarily to that trade or industry; or |
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(2) for a multiple employer welfare arrangement to |
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which Section 846.0035 applies, each have a principal place of |
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business in the same region that does not exceed the boundaries of |
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this state or the boundaries of a metropolitan statistical area |
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designated by the United States Office of Management and Budget. |
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(c) If the employers in the multiple employer welfare |
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arrangement are members of an association, the association must: |
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(1) be engaged in substantial activity for its |
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members other than sponsorship of an employee welfare benefit plan; |
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and |
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(2) if Section 846.0035 does not apply to the multiple |
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employer welfare arrangement, have been in existence for at least |
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two years before engaging in any activities relating to providing |
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employee health benefits to its members. |
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(d-1) For purposes of a multiple employer welfare |
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arrangement to which Section 846.0035 applies, a working owner of a |
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trade or business without employees may qualify as both an employer |
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and as an employee of the trade or industry for the purposes of this |
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section. In this subsection, "working owner" means an individual |
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who: |
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(1) has an ownership right of any nature in a trade or |
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business, whether incorporated or unincorporated, including a |
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partner and other self-employed individual; |
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(2) earns wages or self-employment income from the |
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trade or business for providing personal services to the trade or |
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business; and |
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(3) either: |
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(A) works on average at least 20 hours per week or |
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at least 80 hours per month providing personal services to the |
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working owner's trade or business; or |
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(B) has wages or self-employment income from the |
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individual's trade or business that at least equals the |
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individual's cost of coverage for participation by the individual |
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and any covered beneficiaries in the group health plan sponsored by |
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the group or association in which the individual is participating. |
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SECTION 4. This Act takes effect September 1, 2023. |
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* * * * * |