1-1 By: Averitt (Senate Sponsor - Sibley) H.B. No. 2969
1-2 (In the Senate - Received from the House May 3, 1999;
1-3 May 3, 1999, read first time and referred to Committee on Economic
1-4 Development; May 13, 1999, reported favorably by the following
1-5 vote: Yeas 4, Nays 0; May 13, 1999, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to small and large employer health plan certification,
1-9 discontinuance, and dependent participation requirements.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Article 26.07, Insurance Code, is amended to read
1-12 as follows:
1-13 Art. 26.07. CERTIFICATION. (a) Each [Not later than March
1-14 1 of each year, each] health carrier shall certify, in accordance
1-15 with rules adopted by [to] the commissioner, that the health
1-16 carrier [whether, as of January 1 of that year, it] is offering,
1-17 delivering, issuing for delivery, or renewing, or that the health
1-18 carrier intends to offer, deliver, issue for delivery, or renew a
1-19 health benefit plan to or through a small employer in this state
1-20 that is subject to this chapter under Article 26.06(a) of this
1-21 code.
1-22 (b) A health carrier must submit a revised certification to
1-23 the commissioner only if the health carrier changes its status as a
1-24 small employer carrier or changes its intent to become a small
1-25 employer health carrier to the extent that its previous
1-26 certification ceases to be accurate [The certification shall list
1-27 each other health insurance coverage that:]
1-28 [(1) the health carrier is offering, delivering,
1-29 issuing for delivery, or renewing to or through small employers in
1-30 this state; and]
1-31 [(2) is not subject to this chapter because it is
1-32 listed as excluded from the definition of a health benefit plan
1-33 under Article 26.02 of this code].
1-34 (c) The certification shall include a statement that the
1-35 health carrier is [not offering or marketing to small employers as
1-36 a health benefit plan the coverage listed under Subsection (b) of
1-37 this article and that the health carrier is] complying with this
1-38 chapter to the extent it is applicable to the carrier.
1-39 SECTION 2. Article 26.24(d), Insurance Code, is amended to
1-40 read as follows:
1-41 (d) A small employer carrier may elect to discontinue a
1-42 particular type of small employer coverage only if the small
1-43 employer carrier:
1-44 (1) [provides notice to each employer of the
1-45 discontinuation] before the 90th day preceding the date of the
1-46 discontinuation of the coverage:
1-47 (A) provides notice of the discontinuation to
1-48 the employer and the commissioner; and
1-49 (B) [(2)] offers to each employer the option to
1-50 purchase other small employer coverage offered by the small
1-51 employer carrier at the time of the discontinuation; and
1-52 (2) [(3)] acts uniformly without regard to the claims
1-53 experience of the employer or any health status related factors of
1-54 employees or dependents or new employees or dependents who may
1-55 become eligible for the coverage.
1-56 SECTION 3. Article 26.82, Insurance Code, is amended to read
1-57 as follows:
1-58 Art. 26.82. CERTIFICATION. (a) Each [Not later than March 1
1-59 of each year, each] health carrier shall certify, in accordance
1-60 with rules adopted by [to] the commissioner, that the health
1-61 carrier [whether, as of January 1 of that year, it] is offering,
1-62 delivering, issuing for delivery, or renewing, or that the health
1-63 carrier intends to offer, deliver, issue for delivery, or renew a
1-64 health benefit plan to or through a large employer in this state
2-1 that is subject to this subchapter under Article 26.81 of this
2-2 code.
2-3 (b) A health carrier must submit a revised certification to
2-4 the commissioner only if the health carrier changes its status as a
2-5 large employer carrier or changes its intent to become a small
2-6 employer health carrier to the extent that its previous
2-7 certification ceases to be accurate.
2-8 (c) The certification shall include a statement that the
2-9 health carrier is complying with this chapter to the extent it is
2-10 applicable to the carrier.
2-11 SECTION 4. Article 26.83(e), Insurance Code, is amended to
2-12 read as follows:
2-13 (e) A large employer carrier may require a large employer to
2-14 meet minimum contribution or participation requirements as a
2-15 condition of issuance and renewal in accordance with the carrier's
2-16 usual and customary practices for all employer health benefit plans
2-17 in this state. The participation requirements may determine the
2-18 percentage of eligible employees who meet the participation
2-19 criteria established by the employer who [individuals that] must be
2-20 enrolled in the plan [in accordance with the participation criteria
2-21 established by the employer]. A large employer carrier may apply
2-22 participation requirements to the employer's eligible employees,
2-23 but may not apply those requirements to eligible dependents. Those
2-24 requirements must be stated in the contract and must be applied
2-25 uniformly to each large employer offered or issued coverage by the
2-26 large employer carrier in this state.
2-27 SECTION 5. Article 26.87(d), Insurance Code, is amended to
2-28 read as follows:
2-29 (d) A large employer carrier may elect to discontinue a
2-30 particular type of large employer coverage only if the large
2-31 employer carrier:
2-32 (1) [provides notice to each employer of the
2-33 discontinuation] before the 90th day preceding the date of the
2-34 discontinuation of the coverage:
2-35 (A) provides notice of the discontinuation to
2-36 the employer and the commissioner; and
2-37 (B) [(2)] offers to each employer the option to
2-38 purchase other large employer coverage offered by the large
2-39 employer carrier at the time of the discontinuation; and
2-40 (2) [(3)] acts uniformly without regard to the claims
2-41 experience of the employer or any health status related factors of
2-42 employees or dependents or new employees or dependents who may
2-43 become eligible for the coverage.
2-44 SECTION 6. (a) This Act takes effect September 1, 1999.
2-45 (b) The commissioner of insurance shall adopt rules
2-46 necessary to implement this Act not later than January 1, 2000.
2-47 (c) A health carrier under Article 26.07 or 26.82, Insurance
2-48 Code, as amended by this Act, shall provide the certification
2-49 required by this Act not later than March 1, 2000.
2-50 SECTION 7. The importance of this legislation and the
2-51 crowded condition of the calendars in both houses create an
2-52 emergency and an imperative public necessity that the
2-53 constitutional rule requiring bills to be read on three several
2-54 days in each house be suspended, and this rule is hereby suspended.
2-55 * * * * *