Bill not drafted by TLC or Senate E&E.
Line and page numbers may not match official copy.
By Averitt H.B. No. 2795
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the composition and powers of the Texas Health Benefits
1-3 Purchasing Cooperative; amending Chapter 26, Insurance Code; and
1-4 declaring an emergency.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Article 26.11(4), Insurance Code, is amended to
1-7 read as follows:
1-8 (4) "Texas cooperative" means the Texas Health
1-9 Benefits Purchasing Cooperative, a non-profit corporation,
1-10 established under Article 26.13 of this code.
1-11 SECTION 2. Article 26.13(a), Insurance Code, is amended to
1-12 read as follows:
1-13 Art. 26.13. Texas Health Benefits Purchasing Cooperative.
1-14 (a) The Texas Health Benefits Purchasing Cooperative is a
1-15 nonprofit [organization] corporation established to make health
1-16 care coverage available to small employers and their eligible
1-17 employees and eligible employees' dependents.
1-18 SECTION 3. Article 26.13(b), Insurance Code, is amended to
1-19 read as follows:
1-20 (b) The Texas cooperative is administered by a six-member
1-21 board of trustees appointed by the governor with the advice and
1-22 consent of the senate. Three members must represent employers, two
1-23 members must represent employees, and one member must represent the
1-24 public. [The executive director of the Texas Department of
2-1 Commerce shall serve as a nonvoting ex officio member of the board
2-2 of trustees.]
2-3 SECTION 4. Article 26.13(h), Insurance Code, is amended to
2-4 read as follows:
2-5 (h) The Texas cooperative or a [A] member of the board of
2-6 trustees, the executive director, [and] or an employee or agent of
2-7 the Texas cooperative [are] is not liable for:
2-8 (1) an act performed in good faith in the execution of
2-9 duties in connection with the Texas cooperative; or
2-10 (2) an independent action of a small employer
2-11 insurance carrier or a person who provides health care services
2-12 under a health benefit plan.
2-13 SECTION 5. Article 26.15(a), Insurance Code, is amended by
2-14 adding paragraph 10 to read as follows:
2-15 Art. 26.15. POWERS AND DUTIES OF TEXAS HEALTH BENEFITS
2-16 PURCHASING COOPERATIVE AND PRIVATE PURCHASING COOPERATIVES. (a) A
2-17 cooperative:
2-18 (1) shall arrange for small employer health benefit
2-19 plan coverage for small employer groups who participate in the
2-20 cooperative by contracting with small employer carriers who meet
2-21 the criteria established by Subsection (b) of this article;
2-22 (2) shall collect premiums to cover the cost of:
2-23 (A) small employer health benefit plan coverage
2-24 purchased through the cooperative; and
2-25 (B) the cooperative's administrative expenses;
2-26 (3) may contract with agents to market coverage issued
2-27 through the cooperative;
2-28 (4) shall establish administrative and accounting
2-29 procedures for the operation of the cooperative;
2-30 (5) shall establish procedures under which an
3-1 applicant for or participant in coverage issued through the
3-2 cooperative may have a grievance reviewed by an impartial person;
3-3 (6) may contract with a small employer carrier or
3-4 third-party administrator to provide administrative services to the
3-5 cooperative;
3-6 (7) shall contract with small employer carriers for
3-7 the provision of services to small employers covered through the
3-8 cooperative;
3-9 (8) shall develop and implement a plan to maintain
3-10 public awareness of the cooperative and publicize the eligibility
3-11 requirements for, and the procedures for enrollment in coverage
3-12 through, the cooperative; [and]
3-13 (9) may negotiate the premiums paid by its members;
3-14 and
3-15 (10) may offer such other ancillary products and
3-16 services to its members as are customarily offered in conjunction
3-17 with health benefit plans.
3-18 SECTION 6. Article 26.15(d) is amended to read as follows:
3-19 (d) A cooperative shall comply with federal laws applicable
3-20 to cooperatives and health benefit plans issued through
3-21 cooperatives, to the extent required by state law or rules adopted
3-22 by the Commissioner of Insurance. A cooperative shall comply with
3-23 state laws applicable to cooperatives and health benefit plans
3-24 issued through cooperatives.
3-25 SECTION 7. Article 26.16 is amended to read as follows:
3-26 Art. 26.16. COOPERATIVE NOT INSURER. (a) A cooperative is
3-27 not an insurer and the employees of the cooperative are not
3-28 required to be licensed under Section 15 or 15A, Texas Health
3-29 Maintenance Organization Act (Article 20A.15 or 20A.15A, Vernon's
3-30 Texas Insurance Code), or Subchapter A, Chapter 21, of this code.
4-1 (b) A cooperative is considered an employer solely for the
4-2 purposes of benefit elections under the Code.
4-3 (c) An agent or third-party administrator used and
4-4 compensated by the cooperative must be licensed as required by
4-5 Section 15 or 15A, Texas Health Maintenance Organization Act
4-6 (Article 20A.15 or 20A.15A, Vernon's Texas Insurance Code), or
4-7 Subchapter A, Chapter 21, of this code.
4-8 (d) A licensed agent used and compensated by the cooperative
4-9 need not be appointed by each small employer carrier participating
4-10 in the cooperative in order to market the products and services
4-11 sponsored by the cooperative. However, a licensed agent may not
4-12 market any other non-sponsored product or service of a
4-13 participating small employer carrier without first being appointed
4-14 by the small employer carrier.
4-15 SECTION 8. This act takes effect September 1, 1997.
4-16 SECTION 9. The importance of this legislation and the
4-17 crowded conditions of the calendars in both houses create an
4-18 emergency and an imperative public necessity that the
4-19 constitutional rule requiring bills to be read on three several
4-20 days in each house be suspended, and this rule is hereby suspended.