By Averitt H.B. No. 1867
Line and page numbers may not match official copy.
Bill not drafted by TLC or Senate E&E.
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the fair marketing of health benefit plans.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. SUBCHAPTER G., Chapter 26, Article 26.71(a),
1-5 Insurance Code, is amended to read as follows and Article 26.71 is
1-6 further amended by adding subsection(c):
1-7 (a) Each small employer carrier shall market the small
1-8 employer health benefit plans through any willing [properly
1-9 licensed] agent[s] to eligible small employers in this state. Any
1-10 agent licensed in this state may solicit, negotiate, or effect
1-11 applications for small employer health benefit plans with any small
1-12 employer carrier lawfully doing business in this state other than a
1-13 small employee carrier such agent is licensed to represent, if such
1-14 agent requests appointment with such small employer carrier
1-15 simultaneously with the submission to such small employer carrier
1-16 of the application for small employer health benefit plans
1-17 solicited by him or it. However, no commissions shall be paid by
1-18 such small employer carrier to the agent until such time as notice
1-19 of appointment with respect to such agent has been given to the
1-20 Commissioner pursuant to the provisions of Article 21.07-1 Section
1-21 8., Subsection (a) of this Code. Each small employer purchasing a
1-22 small employer health benefit plan shall be given a summary of the
2-1 benefit plans established by the commissioner under Subchapter E of
2-2 this chapter. The commissioner shall prescribe the format of the
2-3 summary. The agent shall offer and explain each of the plans to
2-4 the small employer on inquiry and request by the small employer.
2-5 (c) A group model health maintenance organization that is a
2-6 nonprofit, state-certified health maintenance organization that
2-7 provides the majority of its professional services through a single
2-8 group medical practice that is governed by a board composed
2-9 entirely of physicians through a contract with the medical school
2-10 component of a Texas state-supported college or university by the
2-11 Accrediting Council on Graduate Medical Education or the American
2-12 Osteopathic Association shall be exempt from the requirement of
2-13 Subsection (a) of this article to market it's health benefit plans
2-14 through any willing agent.
2-15 SECTION 2. SUBCHAPTER G., Chapter 26, Article 26.73(b),
2-16 Insurance Code, is amended to read as follows:
2-17 (b) A small employer carrier may not terminate, fail to
2-18 renew, or limit its contract or agreement of representation with an
2-19 agent for any reason related to the health status or claim
2-20 experience of a small employer group placed by the agent with the
2-21 carrier or for any reason other than fraud or an intentional
2-22 misrepresentation of a material fact unless the carrier and agent
2-23 mutually agree.
2-24 SECTION 3. SUBCHAPTER G., Chapter 26, Article 26.93,
2-25 Insurance Code, is amended to read as follows:
2-26 (a) A large employer carrier may not terminate, fail to
3-1 renew, or limit its contract or agreement of representation with an
3-2 agent because of any health status related factors of a large
3-3 employer group placed by the agent with the carrier or for any
3-4 reason other than fraud or an intentional misrepresentation of a
3-5 material fact unless the carrier and agent mutually agree.
3-6 (b) Each large employer carrier shall market the large
3-7 employer health benefit plans through any willing agent to eligible
3-8 large employers in this state. Any agent licensed in this state
3-9 may solicit, negotiate, or effect applications for large employer
3-10 health benefit plans with any large employer carrier lawfully doing
3-11 business in this state other than a large employer carrier such
3-12 agent is licensed to represent, if such agent requests appointment
3-13 with such large employer carrier simultaneously with the submission
3-14 to such large employer carrier of the application for large
3-15 employer health benefit plans solicited by him or it. However, no
3-16 commissions shall be paid by such large employer carrier to the
3-17 agent until such time as notice of appointment with respect to such
3-18 agent has been given to the Commissioner pursuant to the provisions
3-19 of Article 21.07-1 Section 8., Subsection (a) of this Code.
3-20 (c) A group model health maintenance organization that is a
3-21 nonprofit, state-certified health maintenance organization that
3-22 provides the majority of its professional services through a single
3-23 group medical practice that is governed by a board composed
3-24 entirely of physicians through a contract with the medical school
3-25 component of a Texas state-supported college or university by the
3-26 Accrediting Council on Graduate Medical Education or the American
4-1 Osteopathic Association shall be exempt from the requirement of
4-2 Subsection (b) of this article to market it's health benefit plans
4-3 through any willing agent.
4-4 SECTION 4. This Act takes effect September 1, 2001, and
4-5 applies only to a health benefit plan that is delivered, issued for
4-6 delivery, or renewed on or after January 1, 2002. A health benefit
4-7 plan that is delivered, issued for delivery, or renewed before
4-8 January 1, 2002, is governed by the law as it existed immediately
4-9 before the effective date of this Act, and that law is continued in
4-10 effect for that purpose.