1-1 By: Averitt (Senate Sponsor - Duncan) H.B. No. 2795
1-2 (In the Senate - Received from the House May 5, 1997;
1-3 May 6, 1997, read first time and referred to Committee on Economic
1-4 Development; May 17, 1997, reported favorably by the following
1-5 vote: Yeas 8, Nays 0; May 17, 1997, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to the composition and powers of the Texas Health Benefits
1-9 Purchasing Cooperative; amending Chapter 26, Insurance Code; and
1-10 declaring an emergency.
1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-12 SECTION 1. Article 26.11(4), Insurance Code, is amended to
1-13 read as follows:
1-14 (4) "Texas cooperative" means the Texas Health
1-15 Benefits Purchasing Cooperative, a nonprofit corporation,
1-16 established under Article 26.13 of this code.
1-17 SECTION 2. Article 26.13(a), Insurance Code, is amended to
1-18 read as follows:
1-19 (a) The Texas Health Benefits Purchasing Cooperative is a
1-20 nonprofit corporation [organization] established to make health
1-21 care coverage available to small employers and their eligible
1-22 employees and eligible employees' dependents.
1-23 SECTION 3. Article 26.13(b), Insurance Code, is amended to
1-24 read as follows:
1-25 (b) The Texas cooperative is administered by a six-member
1-26 board of trustees appointed by the governor with the advice and
1-27 consent of the senate. Three members must represent employers, two
1-28 members must represent employees, and one member must represent the
1-29 public. [The executive director of the Texas Department of
1-30 Commerce shall serve as a nonvoting ex officio member of the board
1-31 of trustees.]
1-32 SECTION 4. Article 26.13(h), Insurance Code, is amended to
1-33 read as follows:
1-34 (h) The Texas cooperative or a [A] member of the board of
1-35 trustees, the executive director, or [and] an employee or agent of
1-36 the Texas cooperative is [are] not liable for:
1-37 (1) an act performed in good faith in the execution of
1-38 duties in connection with the Texas cooperative; or
1-39 (2) an independent action of a small employer
1-40 insurance carrier or a person who provides health care services
1-41 under a health benefit plan.
1-42 SECTION 5. Article 26.15(a), Insurance Code, is amended to
1-43 read as follows:
1-44 (a) A cooperative:
1-45 (1) shall arrange for small employer health benefit
1-46 plan coverage for small employer groups who participate in the
1-47 cooperative by contracting with small employer carriers who meet
1-48 the criteria established by Subsection (b) of this article;
1-49 (2) shall collect premiums to cover the cost of:
1-50 (A) small employer health benefit plan coverage
1-51 purchased through the cooperative; and
1-52 (B) the cooperative's administrative expenses;
1-53 (3) may contract with agents to market coverage issued
1-54 through the cooperative;
1-55 (4) shall establish administrative and accounting
1-56 procedures for the operation of the cooperative;
1-57 (5) shall establish procedures under which an
1-58 applicant for or participant in coverage issued through the
1-59 cooperative may have a grievance reviewed by an impartial person;
1-60 (6) may contract with a small employer carrier or
1-61 third-party administrator to provide administrative services to the
1-62 cooperative;
1-63 (7) shall contract with small employer carriers for
1-64 the provision of services to small employers covered through the
2-1 cooperative;
2-2 (8) shall develop and implement a plan to maintain
2-3 public awareness of the cooperative and publicize the eligibility
2-4 requirements for, and the procedures for enrollment in coverage
2-5 through, the cooperative; [and]
2-6 (9) may negotiate the premiums paid by its members;
2-7 and
2-8 (10) may offer such other ancillary products and
2-9 services to its members as are customarily offered in conjunction
2-10 with health benefit plans.
2-11 SECTION 6. Article 26.15(d), Insurance Code, is amended to
2-12 read as follows:
2-13 (d) A cooperative shall comply with federal laws applicable
2-14 to cooperatives and health benefit plans issued through
2-15 cooperatives, to the extent required by state law or rules adopted
2-16 by the commissioner of insurance. A cooperative shall comply with
2-17 state laws applicable to cooperatives and health benefit plans
2-18 issued through cooperatives.
2-19 SECTION 7. Article 26.16, Insurance Code, is amended to read
2-20 as follows:
2-21 Art. 26.16. COOPERATIVE NOT INSURER. (a) A cooperative is
2-22 not an insurer and the employees of the cooperative are not
2-23 required to be licensed under Section 15 or 15A, Texas Health
2-24 Maintenance Organization Act (Article 20A.15 or 20A.15A, Vernon's
2-25 Texas Insurance Code), or Subchapter A, Chapter 21, of this code.
2-26 (b) A cooperative is considered an employer solely for the
2-27 purposes of benefit elections under the code.
2-28 (c) An agent or third-party administrator used and
2-29 compensated by the cooperative must be licensed as required by
2-30 Section 15 or 15A, Texas Health Maintenance Organization Act
2-31 (Article 20A.15 or 20A.15A, Vernon's Texas Insurance Code), or
2-32 Subchapter A, Chapter 21, of this code.
2-33 (d) A licensed agent used and compensated by the cooperative
2-34 need not be appointed by each small employer carrier participating
2-35 in the cooperative in order to market the products and services
2-36 sponsored by the cooperative. However, a licensed agent may not
2-37 market any other non-sponsored product or service of a
2-38 participating small employer carrier without first being appointed
2-39 by the small employer carrier.
2-40 SECTION 8. This Act takes effect September 1, 1997.
2-41 SECTION 9. The importance of this legislation and the
2-42 crowded condition of the calendars in both houses create an
2-43 emergency and an imperative public necessity that the
2-44 constitutional rule requiring bills to be read on three several
2-45 days in each house be suspended, and this rule is hereby suspended.
2-46 * * * * *