79R1303 DLF-D
By: Averitt S.B. No. 805
A BILL TO BE ENTITLED
AN ACT
relating to certain small and large employer health cooperatives.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 1501, Insurance Code, as
effective April 1, 2005, and as amended by the Act of the 79th
Legislature, Regular Session, 2005, relating to nonsubstantive
additions to and corrections in enacted codes (the general code
update bill), is amended by adding Section 1501.0575 to read as
follows:
Sec. 1501.0575. VOLUNTARY PARTICIPATION BY ISSUER IN
COOPERATIVE. A health benefit plan issuer may elect not to
participate in a health group cooperative. The health benefit plan
issuer may elect to participate in one or more health group
cooperatives and may select the cooperatives in which the issuer
will participate.
SECTION 2. Section 1501.0581, Insurance Code, as effective
April 1, 2005, and as amended by the Act of the 79th Legislature,
Regular Session, 2005, relating to nonsubstantive additions to and
corrections in enacted codes (the general code update bill), is
amended by amending Subsections (a), (b), and (c) and adding
Subsections (o) and (p) to read as follows:
(a) The membership of a health group cooperative may consist
only of small employers or may consist only of large employers, but
may not[, at the option of the health group cooperative,] consist of
both small and large employers. To participate as a member of a
health group cooperative, an employer must be a small or large
employer as described by this chapter.
(b) Subject to the requirements imposed on small employer
health benefit plan issuers under Section 1501.101, a health group
cooperative:
(1) shall allow a small employer to join a [the] health
group cooperative consisting only of small employers and enroll in
health benefit plan coverage, subject to Subsection (o); and
(2) may allow a large employer to join a [the] health
group cooperative consisting only of large employers and enroll in
health benefit plan coverage.
(c) Subject to Subsection (o), a [A] health group
cooperative consisting only of small employers shall allow any
small employer to join the health group cooperative and enroll in
the cooperative's health benefit plan coverage during the initial
enrollment and annual open enrollment periods.
(o) A health group cooperative consisting only of small
employers is not required to allow a small employer to join the
health group cooperative under Subsection (c) if:
(1) the cooperative has elected to restrict membership
in the cooperative in accordance with this subsection and
Subsection (p); and
(2) after the small employer has joined the
cooperative, the total number of eligible employees employed on
business days during the preceding calendar year by all small
employers participating in the cooperative would exceed 50.
(p) A health group cooperative must make the election
described by Subsection (o) at the time the cooperative is
initially formed. Evidence of the election must be filed in writing
with the commissioner in the form and at the time prescribed by the
commissioner by rule.
SECTION 3. Section 1501.063(b), Insurance Code, as
effective April 1, 2005, and as amended by the Act of the 79th
Legislature, Regular Session, 2005, relating to nonsubstantive
additions to and corrections in enacted codes (the general code
update bill), is amended to read as follows:
(b) A health group cooperative that is composed only of
small employers and otherwise qualifies under this subsection is
considered a single employer under this code and shall be treated in
the same manner as a small employer for the purposes of this
chapter, including for the purposes of any provision relating to
premium rates and issuance and renewal of coverage. A cooperative
qualifies for treatment as a single small employer under this
subsection only if the total number of eligible employees employed
on business days during the preceding calendar year by all small
employers participating in the cooperative does not exceed 50. [A
health group cooperative that is composed of small and large
employers is considered a single employer under this code and, in
relation to the small employers that are members of the
cooperative, shall be treated in the same manner as a small
employer. A health group cooperative that is composed of small and
large employers may elect to extend the protections of this chapter
that are applicable to small employer groups to the large employer
groups that participate in the cooperative.] A health group
cooperative shall have sole authority to make benefit elections and
perform other administrative functions under this code for the
cooperative's participating employers.
SECTION 4. Notwithstanding Section 1501.0581(p), Insurance
Code, as added by this Act, a health group cooperative in existence
on the effective date of this Act may make the election described by
Section 1501.0581(o), Insurance Code, as added by this Act, not
later than December 31, 2005.
SECTION 5. This Act takes effect only if the Act of the 79th
Legislature, Regular Session, 2005, relating to nonsubstantive
additions to and corrections in enacted codes becomes law. If the
Act of the 79th Legislature, Regular Session, 2005, relating to
nonsubstantive additions to and corrections in enacted codes does
not become law, this Act has no effect.
SECTION 6. To the extent of any conflict, this Act prevails
over another Act of the 79th Legislature, Regular Session, 2005,
relating to nonsubstantive additions to and corrections in enacted
codes.
SECTION 7. This Act takes effect September 1, 2005.