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A BILL TO BE ENTITLED
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AN ACT
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relating to insurance regulation of a prepaid health care plan for |
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certain individuals with low income. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle K, Title 8, Insurance Code, is amended |
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by adding Chapter 1683 to read as follows: |
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CHAPTER 1683. PREPAID HEALTH CARE PLAN FOR CERTAIN INDIVIDUALS |
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WITH LOW INCOME |
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Sec. 1683.001. INSURANCE REGULATION OF PREPAID HEALTH CARE |
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PLAN FOR CERTAIN INDIVIDUALS WITH LOW INCOME. A plan for providing |
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health care to individuals with low income on a prepaid basis is not |
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considered to be engaging in the business of insurance if: |
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(1) eligibility in the plan is limited to: |
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(A) individuals not covered under any other group |
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insurance or health benefit plan arrangement whose incomes are at |
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or below 400 percent of the federal poverty level and who are: |
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(i) employed by a business employing 200 or |
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fewer eligible individuals; or |
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(ii) engaged in domestic service in private |
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households; and |
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(B) dependents of individuals described by |
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Paragraph (A); |
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(2) the plan is operated on a nonprofit basis under the |
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sponsorship of a nonprofit organization; |
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(3) covered primary care services are provided to |
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enrollees by health care practitioners who: |
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(A) have agreed to provide their services for |
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free or nominal reimbursement for out-of-pocket expenses or |
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expendable supplies directly related to, and incurred as a result |
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of, the service provided to the enrollee; and |
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(B) are either: |
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(i) health care practitioners on staff of |
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the sponsoring organization; or |
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(ii) volunteer practitioners recruited |
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from a county medical society; |
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(4) payments to outside contractors for marketing, |
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claims administration, and similar services total not more than 10 |
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percent of the total charges imposed by the plan; |
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(5) the plan has received the approval and endorsement |
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of the county medical society in consultation with the Texas |
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Medical Association; |
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(6) except as provided by Subdivision (3), the plan |
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does not pay a portion of any fees or charges imposed under the plan |
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directly or indirectly as salary to an officer or director of the |
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sponsoring nonprofit organization; and |
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(7) the sponsoring nonprofit organization files an |
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annual report with the commissioner in the form and manner |
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prescribed by the commissioner not later than the 90th day after the |
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end of the corporation's fiscal year that includes: |
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(A) the number of plan enrollees; |
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(B) the total number of services provided under |
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the plan; |
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(C) the plan's financial statements; |
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(D) the administrative costs and salaries paid by |
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the plan; and |
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(E) any other information reasonably requested |
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by the commissioner. |
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SECTION 2. This Act takes effect September 1, 2023. |