By: Patterson S.B. No. 708
73R1265 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to group health insurance for certain small employers.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Subchapter E, Chapter 3, Insurance Code, is
1-5 amended by adding Article 3.51-6E to read as follows:
1-6 Art. 3.51-6E. GROUP HEALTH INSURANCE PLANS FOR CERTAIN SMALL
1-7 EMPLOYERS
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Dependent" means the spouse or dependent child of
1-10 an employee, officer, partner, or sole proprietor covered by a
1-11 small employer basic health plan.
1-12 (2) "Group health insurer" means an insurance company
1-13 that writes group health insurance in this state, including a
1-14 company subject to Chapter 20 of this code and a health maintenance
1-15 organization subject to the Texas Health Maintenance Organization
1-16 Act (Chapter 20A, Vernon's Texas Insurance Code).
1-17 (3) "Small employer basic health plan" means a health
1-18 benefits plan that complies with Section 2 of this article.
1-19 (4) "Small employer" means a person, firm,
1-20 corporation, partnership, or association actively engaged in
1-21 business that, on at least 50 percent of its working days during
1-22 the year preceding the date on which coverage under a basic health
1-23 benefits plan begins, employed at least three and not more than 50
1-24 employees.
2-1 Sec. 2. REQUIRED BENEFITS AND COVERAGES. (a) A group
2-2 health insurer may offer a small employer basic health plan to
2-3 provide health care benefits for the employees of a small employer.
2-4 The plan must provide benefits for:
2-5 (1) inpatient hospital care for at least 20 days each
2-6 policy year;
2-7 (2) outpatient hospital care, including surgery,
2-8 anaesthesia, preadmission testing, and radiation and chemotherapy;
2-9 (3) emergency care for life-threatening conditions;
2-10 (4) at least four physician visits during each policy
2-11 year, including laboratory fees, surgery, and anaesthesia;
2-12 (5) at least six pediatric physician visits during the
2-13 first year of a covered child's life;
2-14 (6) medically appropriate immunizations during the
2-15 first eight years of a covered child's life; and
2-16 (7) maternity care, including prenatal care office
2-17 visits, hospital care for mother and newborn, and hospital nursery
2-18 care.
2-19 (b) Benefits offered under a small employer basic health
2-20 plan may be subject to:
2-21 (1) reasonable deductibles, coinsurance, or copayments
2-22 in amounts approved by the commissioner; and
2-23 (2) a lifetime maximum benefit of not less than
2-24 $250,000 per covered person.
2-25 (c) Coverage under a small employer basic health plan
2-26 offered to a small employer must be made available to each:
2-27 (1) employee of the small employer; and
3-1 (2) dependent of an employee who is covered under the
3-2 plan.
3-3 (d) Coverage under a small employer basic health plan
3-4 offered to a small employer may be made available to an officer,
3-5 partner, or sole proprietor of a business entity that is a small
3-6 employer and to the dependents of the officer, partner, or sole
3-7 proprietor.
3-8 (e) A small employer basic health plan may provide more
3-9 comprehensive benefits than the benefits required by this section.
3-10 Sec. 3. TERMINATION OF COVERAGE. (a) A small employer
3-11 basic health plan may not be terminated by the small employer
3-12 carrier except for:
3-13 (1) nonpayment by the small employer of a required
3-14 premium or contribution;
3-15 (2) fraud or misrepresentation by the small employer;
3-16 or
3-17 (3) noncompliance with renewability provisions
3-18 approved by the commissioner.
3-19 (b) Coverage under a small employer basic health plan for an
3-20 employee or dependent of an employee may not be terminated except
3-21 for:
3-22 (1) nonpayment of a required premium or contribution;
3-23 or
3-24 (2) fraud or misrepresentation.
3-25 Sec. 4. MANDATED BENEFITS PROVISIONS INAPPLICABLE. Except
3-26 as provided by Section 2 of this article, a law requiring the
3-27 coverage of a health care service or benefit, the coverage of a
4-1 particular person or class of persons, specific contract
4-2 provisions, or the reimbursement, use, or consideration of a
4-3 specific category of health care practitioners or providers does
4-4 not apply to a small employer basic health care plan.
4-5 SECTION 2. This Act takes effect September 1, 1993, and
4-6 applies only to an insurance policy that is delivered, issued for
4-7 delivery, or renewed on or after January 1, 1994. A policy that is
4-8 delivered, issued for delivery, or renewed before January 1, 1994,
4-9 is governed by the law as it existed immediately before the
4-10 effective date of this Act, and that law is continued in effect for
4-11 that purpose.
4-12 SECTION 3. The importance of this legislation and the
4-13 crowded condition of the calendars in both houses create an
4-14 emergency and an imperative public necessity that the
4-15 constitutional rule requiring bills to be read on three several
4-16 days in each house be suspended, and this rule is hereby suspended.