By:  Averitt                                                      S.B. No. 1670


A BILL TO BE ENTITLED

AN ACT

relating to the ability of a health maintenance organization to 
provide accessible and affordable benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Article 26.48, Insurance Code, is amended to 
read as follows:    
	Art. 26.48.  HEALTH MAINTENANCE ORGANIZATION PLANS.  (a)  A 
health maintenance organization may offer:
		(1)  a state-approved health benefit plan that complies 
with this chapter, the Texas Health Maintenance Organization Act 
(Chapter 20A, Vernon's Texas Insurance Code), Title XIII, Public 
Health Service Act (42 U.S.C. Section 300e et seq.), and its 
subsequent amendments, and rules adopted under these laws;
		(2)  a plan developed by the commissioner under Article 
26.44A of this code and additional benefit riders to the plan; or
		(3)  a point-of-service contract in connection with an 
insurance carrier that includes optional coverage for out-of-area 
services, emergency care, or out-of-network care.
	(b) A contract offered by an insurance carrier under 
Subsection (a)(3) of this article is subject to all provisions of 
this chapter unless specifically exempted.  The insurance carrier 
with which the health maintenance organization contracts for a 
point-of-service contract is not required to otherwise make 
available the benefit plans adopted under Subchapter E of this 
chapter if the insurance carrier's small employer products are 
limited to the point-of-service contract.
	(c)  A contract offered by a health maintenance organization 
under Subsection (a)(1) of this article is not subject to any 
restrictions or limitations on cost sharing provisions in 42 U.S.C. 
Section 300e(b) and any rules adopted thereunder.
	SECTION 2.  Subsection (l), Section 9, Texas Health 
Maintenance Organization Act (Article 20A.09, Vernon's Texas 
Insurance Code), as added by Chapter 1026, Acts of the 75th 
Legislature, Regular Session, 1997, is amended to read as follows:
	(l)  A health maintenance organization that offers a basic 
health care plan shall provide or arrange for the provision of basic 
health care services to its enrollees as needed and may impose 
[without] limitations as to time and cost except where prohibited 
by state or federal law or [other than limitations prescribed by] 
rule of the commissioner.
	SECTION 3.  Article 26.38, Insurance Code, is amended to 
read as follows:    
	Art. 26.38.  HEALTH MAINTENANCE ORGANIZATION; APPROVED 
HEALTH BENEFIT PLAN.  (a)  The premium rates for a state-approved 
health benefit plan offered by a health maintenance organization 
under Article 26.48 of this code must be established in accordance 
with formulas or schedules of charges filed with the department.
	(b)  A health maintenance organization that participates in 
a purchasing cooperative that provides employees of small employers 
a choice of benefit plans, that has established a separate class of 
business as provided by Article 26.31 of this code, and that has 
established a separate line of business as provided under Article 
26.48(a) of this code and Title XIII, Public Health Service Act (42 
U.S.C. Section 300e et seq.):
		(1)  may use rating methods in accordance with this 
subchapter that are used by other small employer carriers 
participating in the same cooperative, including rating by age and 
gender; and
		(2)  is not subject to any restrictions or limitations 
on cost sharing provisions in 42 U.S.C. Section 300e(b) and any 
rules adopted thereunder.
	SECTION 4.  This Act takes effect immediately if it receives 
a vote of two-thirds of all the members elected to each house, as 
provided by Section 39, Article III, Texas Constitution.  If this 
Act does not receive the vote necessary for immediate effect, this 
Act takes effect September 1, 2003.