By Averitt H.B. No. 2969
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to small and large employer health plan certification,
1-3 discontinuance, and dependent participation requirements.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 26.07, Insurance Code, is amended to read
1-6 as follows:
1-7 Art. 26.07. CERTIFICATION. (a) Each [Not later than March
1-8 1 of each year, each] health carrier shall certify, in accordance
1-9 with rules adopted by [to] the commissioner, that the health
1-10 carrier [whether, as of January 1 of that year, it] is offering,
1-11 delivering, issuing for delivery, or renewing, or that the health
1-12 carrier intends to offer, deliver, issue for delivery, or renew a
1-13 health benefit plan to or through a small employer in this state
1-14 that is subject to this chapter under Article 26.06(a) of this
1-15 code.
1-16 (b) A health carrier must submit a revised certification to
1-17 the commissioner only if the health carrier changes its status as a
1-18 small employer carrier or changes its intent to become a small
1-19 employer health carrier to the extent that its previous
1-20 certification ceases to be accurate [The certification shall list
1-21 each other health insurance coverage that:]
1-22 [(1) the health carrier is offering, delivering,
1-23 issuing for delivery, or renewing to or through small employers in
1-24 this state; and]
2-1 [(2) is not subject to this chapter because it is
2-2 listed as excluded from the definition of a health benefit plan
2-3 under Article 26.02 of this code].
2-4 (c) The certification shall include a statement that the
2-5 health carrier is [not offering or marketing to small employers as
2-6 a health benefit plan the coverage listed under Subsection (b) of
2-7 this article and that the health carrier is] complying with this
2-8 chapter to the extent it is applicable to the carrier.
2-9 SECTION 2. Article 26.24(d), Insurance Code, is amended to
2-10 read as follows:
2-11 (d) A small employer carrier may elect to discontinue a
2-12 particular type of small employer coverage only if the small
2-13 employer carrier:
2-14 (1) [provides notice to each employer of the
2-15 discontinuation] before the 90th day preceding the date of the
2-16 discontinuation of the coverage:
2-17 (A) provides notice of the discontinuation to
2-18 the employer and the commissioner; and
2-19 (B) [(2)] offers to each employer the option to
2-20 purchase other small employer coverage offered by the small
2-21 employer carrier at the time of the discontinuation; and
2-22 (2) [(3)] acts uniformly without regard to the claims
2-23 experience of the employer or any health status related factors of
2-24 employees or dependents or new employees or dependents who may
2-25 become eligible for the coverage.
2-26 SECTION 3. Article 26.82, Insurance Code, is amended to read
2-27 as follows:
3-1 Art. 26.82. CERTIFICATION. (a) Each [Not later than March 1
3-2 of each year, each] health carrier shall certify, in accordance
3-3 with rules adopted by [to] the commissioner, that the health
3-4 carrier [whether, as of January 1 of that year, it] is offering,
3-5 delivering, issuing for delivery, or renewing, or that the health
3-6 carrier intends to offer, deliver, issue for delivery, or renew a
3-7 health benefit plan to or through a large employer in this state
3-8 that is subject to this subchapter under Article 26.81 of this
3-9 code.
3-10 (b) A health carrier must submit a revised certification to
3-11 the commissioner only if the health carrier changes its status as a
3-12 large employer carrier or changes its intent to become a small
3-13 employer health carrier to the extent that its previous
3-14 certification ceases to be accurate.
3-15 (c) The certification shall include a statement that the
3-16 health carrier is complying with this chapter to the extent it is
3-17 applicable to the carrier.
3-18 SECTION 4. Article 26.83(e), Insurance Code, is amended to
3-19 read as follows:
3-20 (e) A large employer carrier may require a large employer to
3-21 meet minimum contribution or participation requirements as a
3-22 condition of issuance and renewal in accordance with the carrier's
3-23 usual and customary practices for all employer health benefit plans
3-24 in this state. The participation requirements may determine the
3-25 percentage of eligible employees who meet the participation
3-26 criteria established by the employer who [individuals that] must be
3-27 enrolled in the plan [in accordance with the participation criteria
4-1 established by the employer]. A large employer carrier may apply
4-2 participation requirements to the employer's eligible employees,
4-3 but may not apply those requirements to eligible dependents. Those
4-4 requirements must be stated in the contract and must be applied
4-5 uniformly to each large employer offered or issued coverage by the
4-6 large employer carrier in this state.
4-7 SECTION 5. Article 26.87(d), Insurance Code, is amended to
4-8 read as follows:
4-9 (d) A large employer carrier may elect to discontinue a
4-10 particular type of large employer coverage only if the large
4-11 employer carrier:
4-12 (1) [provides notice to each employer of the
4-13 discontinuation] before the 90th day preceding the date of the
4-14 discontinuation of the coverage:
4-15 (A) provides notice of the discontinuation to
4-16 the employer and the commissioner; and
4-17 (B) [(2)] offers to each employer the option to
4-18 purchase other large employer coverage offered by the large
4-19 employer carrier at the time of the discontinuation; and
4-20 (2) [(3)] acts uniformly without regard to the claims
4-21 experience of the employer or any health status related factors of
4-22 employees or dependents or new employees or dependents who may
4-23 become eligible for the coverage.
4-24 SECTION 6. (a) This Act takes effect September 1, 1999.
4-25 (b) The commissioner of insurance shall adopt rules
4-26 necessary to implement this Act not later than January 1, 2000.
4-27 (c) A health carrier under Article 26.07 or 26.82, Insurance
5-1 Code, as amended by this Act, shall provide the certification
5-2 required by this Act not later than March 1, 2000.
5-3 SECTION 7. The importance of this legislation and the
5-4 crowded condition of the calendars in both houses create an
5-5 emergency and an imperative public necessity that the
5-6 constitutional rule requiring bills to be read on three several
5-7 days in each house be suspended, and this rule is hereby suspended.