By Shields H.B. No. 129
Substitute the following for H.B. No. 129:
By Shields C.S.H.B. No. 129
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to medical savings accounts; providing a penalty.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. DEFINITIONS. In this Act:
1-5 (1) "Account" means a medical savings account
1-6 established under this Act.
1-7 (2) "Account administrator" means a person qualified
1-8 to act as an account administrator under Section 3 of this Act.
1-9 (3) "Account holder" means:
1-10 (A) an employee of an employer if the employer
1-11 contributes to a medical savings account on that employee's behalf;
1-12 or
1-13 (B) an individual who makes contributions to a
1-14 medical savings account on the individual's own behalf.
1-15 (4) "Dependent" means:
1-16 (A) the spouse of an account holder;
1-17 (B) a child of an account holder who is:
1-18 (i) under 19 years of age, including a
1-19 newborn child;
1-20 (ii) under 23 years of age and enrolled as
1-21 a full-time student at an accredited institution of higher
1-22 education; or
1-23 (iii) medically certified as mentally or
1-24 physically disabled and who is financially dependent on the account
2-1 holder; or
2-2 (C) any person who must be covered under:
2-3 (i) Section 3D or 3E, Article 3.51-6,
2-4 Insurance Code; or
2-5 (ii) Section 2(L), Chapter 397, Acts of
2-6 the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
2-7 Vernon's Texas Insurance Code).
2-8 (5) "Health plan" means any plan that provides
2-9 benefits for health care services or for medical or surgical
2-10 expenses incurred as a result of accident or sickness including:
2-11 (A) an individual, group, blanket, or franchise
2-12 insurance policy;
2-13 (B) an evidence of coverage issued by a health
2-14 maintenance organization under the Texas Health Maintenance
2-15 Organization Act (Chapter 20A, Vernon's Texas Insurance Code);
2-16 (C) a group hospital service contract issued by
2-17 a group hospital service corporation under Chapter 20, Insurance
2-18 Code; or
2-19 (D) an employer-funded health benefit plan,
2-20 including a self-insured health benefit plan.
2-21 (6) "Person" means an individual, corporation,
2-22 government or governmental subdivision or agency, business trust,
2-23 estate, trust, partnership, association, or any other legal entity.
2-24 (7) "Program" means a medical savings account program
2-25 established under this Act.
2-26 SECTION 2. ACCOUNT AUTHORIZED. (a) An individual may
2-27 establish a medical savings account program for the benefit of the
3-1 individual and the individual's dependents. An employer may
3-2 establish a medical savings account program for the benefit of the
3-3 employer's employees and the employees' dependents.
3-4 (b) A program established under this section must provide
3-5 for:
3-6 (1) the contribution into a medical savings account by
3-7 the account holder or by the employer on behalf of the account
3-8 holder; and
3-9 (2) an account administrator to manage the medical
3-10 savings account.
3-11 (c) The program may provide for a health plan to provide
3-12 coverage for each account holder and the dependents of the account
3-13 holder.
3-14 (d) An employer that establishes a medical savings account
3-15 program shall make an annual contribution of at least $1,000 for
3-16 the benefit of each employee who is an account holder.
3-17 (e) An employer that offers a program shall inform each
3-18 employee in writing of the federal tax consequences of the
3-19 contributions made by the employer before making a contribution on
3-20 behalf of that employee.
3-21 SECTION 3. ACCOUNT ADMINISTRATOR. (a) The following
3-22 persons may act as an account administrator under this Act:
3-23 (1) a bank, savings and loan association, savings
3-24 bank, or credit union chartered under the laws of this state or the
3-25 United States;
3-26 (2) a trust company authorized to act as a fiduciary;
3-27 (3) an insurance company authorized to do business in
4-1 this state under Chapter 3, Insurance Code, a group hospital
4-2 service corporation authorized to do business in this state under
4-3 Chapter 20, Insurance Code, or a health maintenance organization
4-4 authorized to do business in this state under the Texas Health
4-5 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
4-6 Code);
4-7 (4) a third-party administrator holding a certificate
4-8 of authority issued under Article 21.07-6, Insurance Code;
4-9 (5) a certified public accountant licensed by the
4-10 Texas State Board of Public Accountancy; or
4-11 (6) an employer that:
4-12 (A) operates a self-insured health plan under
4-13 the Employee Retirement Income Security Act of 1974 (29 U.S.C.
4-14 Section 1001 et seq.); or
4-15 (B) participates in the medical savings account
4-16 program established under this Act.
4-17 (b) If the account administrator is not an employer under
4-18 Subsection (a)(8) of this section, the account administrator may
4-19 charge a fee. The amount of the fee may not exceed 10 percent of
4-20 the amount deposited to the account in a year and shall be
4-21 established by an agreement between the account administrator and
4-22 the employer or account holder.
4-23 (c) The account administrator is the fiduciary of the
4-24 account holder.
4-25 SECTION 4. IDENTIFICATION CARDS. (a) The account
4-26 administrator shall issue to the account holder an identification
4-27 card indicating:
5-1 (1) the name of the account holder and any dependent
5-2 of the account holder for whom eligible expenses may be paid under
5-3 the program;
5-4 (2) the name, address, and phone number of the account
5-5 administrator; and
5-6 (3) whether or not the account holder is covered by a
5-7 health plan that is qualified for purposes of Section 9 of this
5-8 Act.
5-9 (b) The account administrator shall issue a duplicate
5-10 identification card to each dependent of an account holder for whom
5-11 eligible expenses may be paid under the program.
5-12 SECTION 5. USE OF ACCOUNT; PENALTY. (a) The account
5-13 administrator shall use money in an account for either or both of
5-14 the following purposes:
5-15 (1) to pay eligible medical expenses of the account
5-16 holder or the account holder's dependents or to reimburse the
5-17 account holder for these expenses; or
5-18 (2) to purchase a health plan that provides benefits
5-19 for the account holder and the account holder's dependents.
5-20 (b) A medical expense is eligible for payment or
5-21 reimbursement under Subsection (a) of this section if:
5-22 (1) it is a medical expense described under Section
5-23 213(d), Internal Revenue Code (26 U.S.C. Section 213(d)); and
5-24 (2) payment or reimbursement for the expense is not
5-25 otherwise provided for under any health plan or other insurance
5-26 policy, including a motor vehicle or workers' compensation
5-27 insurance policy.
6-1 (c) An account holder commits an offense if the account
6-2 holder:
6-3 (1) submits a false, deceptive, or misleading claim to
6-4 an account administrator to obtain reimbursement for an expense
6-5 that the account holder knows is not reimbursable under Subsection
6-6 (a)(1) of this section; or
6-7 (2) knowingly seeks or obtains reimbursement for an
6-8 expense that was not incurred by the account holder.
6-9 (d) An offense under Subsection (c) of this section is a
6-10 Class C misdemeanor.
6-11 SECTION 6. PROMPT PAYMENT OF CLAIMS. (a) Except as
6-12 provided by Subsection (b) of this section, the account
6-13 administrator shall pay a claim that is eligible for payment from
6-14 the account not later than the 30th day after the date the claim is
6-15 submitted to the account administrator.
6-16 (b) The account administrator may request documents
6-17 necessary to verify whether a claim is eligible for payment from
6-18 the account. If the account administrator makes a request under
6-19 this subsection, the account administrator shall pay a claim that
6-20 is eligible for payment from the account not later than the 30th
6-21 day after the date the documents are received by the account
6-22 administrator.
6-23 SECTION 7. EMPLOYER ADVANCES. (a) If, in any month, an
6-24 account holder or a dependent of an account holder incurs a medical
6-25 expense that is eligible for payment or reimbursement under Section
6-26 5(a) of this Act from an account established by an employer and
6-27 that exceeds the amount of money in the account, the employer may
7-1 advance to the employee the amount necessary to cover the expenses.
7-2 (b) An advance under this section shall be made free of
7-3 interest.
7-4 (c) An employee on whose behalf an advance is made under
7-5 this section is liable to the employer for the amount of the
7-6 advance, and the employer who made the advance may set off the
7-7 amount of the advance against future contributions to the account.
7-8 SECTION 8. MANDATED BENEFITS LAWS INAPPLICABLE TO HEALTH
7-9 PLAN FOR EMPLOYER PROGRAM. (a) Except as provided by Subsection
7-10 (b) of this section, a health plan, including a health benefit plan
7-11 that is qualified for purposes of Section 9 of this Act, is not
7-12 subject to a law that requires coverage or the offer of coverage of
7-13 a specific health care service or benefit if the health plan is:
7-14 (1) purchased by an employer under Section 2(c) of
7-15 this Act in conjunction with the establishment of a medical savings
7-16 account program for the benefit of the employer's employees and the
7-17 employees' dependents; or
7-18 (2) purchased under Section 5(a)(2) of this Act by the
7-19 account administrator of a medical savings account program
7-20 established by an employer for the benefit of the employer's
7-21 employees and the employees' dependents.
7-22 (b) A health plan described by Subsection (a) of this
7-23 section is subject to Chapter 26, Insurance Code, to the extent
7-24 that chapter would otherwise be applicable to the plan.
7-25 SECTION 9. QUALIFIED HEALTH PLAN; ACCESS TO SERVICES. (a)
7-26 A hospital or emergency clinic may not refuse to provide services
7-27 to an individual on the basis of that individual's ability to pay
8-1 for the services if the individual presents an identification card
8-2 issued under Section 4 of this Act that indicates the person is
8-3 covered by a qualified health plan.
8-4 (b) A hospital may delay providing services to an individual
8-5 for a period of not longer than 24 hours to contact the account
8-6 administrator to confirm the individual's participation in a
8-7 program. The hospital may not delay the provision of services
8-8 needed on an emergency basis under this subsection.
8-9 (c) A health plan is qualified for purposes of this section
8-10 if the plan is subject to an annual deductible of not more than
8-11 $2,000 for each individual covered under the plan.
8-12 SECTION 10. DEATH OF ACCOUNT HOLDER. (a) On the death of
8-13 the account holder, the account administrator shall transfer the
8-14 account to a dependent of the account holder named as a successor
8-15 account holder by the account holder in the agreement establishing
8-16 the account. If the agreement does not designate a successor
8-17 account holder, the account administrator shall pay to the estate
8-18 of the deceased account holder any money in the account, including
8-19 any interest on the account.
8-20 (b) If an account is transferred to a successor account
8-21 holder under this section, the account administrator shall continue
8-22 to administer the account for the benefit of the dependents of the
8-23 original account holder.
8-24 (c) A successor account holder may contribute to the
8-25 account. If an account established by an employer is transferred
8-26 to a successor account holder, the employer's obligation to
8-27 contribute to the account is terminated.
9-1 (d) An account administrator shall make the transfer or
9-2 payment required by Subsection (a) of this section not later than
9-3 the 30th day after the date on which the account administrator
9-4 receives proof of the death of the account holder.
9-5 SECTION 11. TRANSFER OF ACCOUNT. (a) On the request of the
9-6 account holder, the account administrator shall pay any money in
9-7 the account, including interest earned on the account, to another
9-8 account established under this Act for the benefit of the account
9-9 holder.
9-10 (b) If the account holder ceases to be employed by an
9-11 employer who has established a program under this Act, the
9-12 administrator shall, not later than the 60th day after the account
9-13 holder's last day of employment, pay any money in the account,
9-14 including interest earned on the account:
9-15 (1) to the account holder; or
9-16 (2) at the option of the account holder, to the credit
9-17 of another account established under this Act for the benefit of
9-18 the account holder.
9-19 (c) The account administrator may not pay money in the
9-20 account to the credit of an account established by an employer of
9-21 an account holder unless the employer agrees to the transfer.
9-22 (d) The account administrator of an account established by
9-23 an employer may retain and continue to administer the account for
9-24 the benefit of an account holder whose employment with the employer
9-25 has terminated if, not later than the 30th day after the account
9-26 holder's last day of employment, the account holder requests that
9-27 the account administrator do so.
10-1 SECTION 12. EMERGENCY. The importance of this legislation
10-2 and the crowded condition of the calendars in both houses create an
10-3 emergency and an imperative public necessity that the
10-4 constitutional rule requiring bills to be read on three several
10-5 days in each house be suspended, and this rule is hereby suspended,
10-6 and that this Act take effect and be in force from and after its
10-7 passage, and it is so enacted.