80R1875 DLF-D
 
  By: Nelson S.B. No. 23
 
 
 
   
 
 
A BILL TO BE ENTITLED
AN ACT
relating to promoting the purchase and availability of health
coverage.
       BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
ARTICLE 1.  TEXLINK TO HEALTH COVERAGE PROGRAM
       SECTION 1.01.  Chapter 524, Insurance Code, is amended to
read as follows:
CHAPTER 524.  TEXLINK TO HEALTH COVERAGE [AWARENESS AND EDUCATION]
PROGRAM
SUBCHAPTER A.  GENERAL PROVISIONS
       Sec. 524.001.  DEFINITIONS.  In this chapter:
             (1)  "Division" means the TexLink to health coverage
division of the department.
             (2)  "Program" means the TexLink to Health Coverage
Program established in accordance with this chapter.
       Sec. 524.002.  TEXLINK TO HEALTH COVERAGE DIVISION.  The
TexLink to health coverage division is a division in the
department.  Under the direction of the commissioner, the division
implements this chapter and performs other duties assigned to the
division under this code.
       Sec. 524.003.  TEXLINK TO HEALTH COVERAGE PROGRAM
ESTABLISHED.  (a)  The department shall develop and implement a
TexLink to health coverage [public awareness and education] program
that complies with this chapter. The program must:
             (1)  educate the public about the importance and value
of health coverage;
             (2)  promote personal responsibility for health care
through the purchase of health coverage;
             (3)  assist small employers, individuals, and others
seeking to purchase health coverage with technical information
necessary to understand available health coverage products;
             (4)  promote and facilitate the development and
availability of new health coverage options;
             (5)  increase public awareness of health coverage
options available in this state; and
             (6) [(2)  educate the public on the value of health
coverage; and
             [(3)]  provide information on health coverage options,
including health savings accounts and compatible high deductible
health benefit plans.
       (b)  The program must include a public awareness and
education component.
SUBCHAPTER B.  PUBLIC AWARENESS AND EDUCATION
       Sec. 524.051.  INFORMATION ABOUT SPECIFIC HEALTH BENEFIT
PLAN ISSUERS.  In materials produced for the program, the division
[(b) The department] may include information about specific health
benefit plan [coverage] issuers but may not favor or endorse one
particular issuer over another.
       Sec. 524.052.  [524.002.] PUBLIC SERVICE ANNOUNCEMENTS.  The
division [department] shall develop and make public service
announcements to educate consumers and employers about the
availability of health coverage in this state.
       Sec. 524.053.  [524.003.] INTERNET WEBSITE; PRINTED
MATERIALS; NEWSLETTER [PUBLIC EDUCATION].  (a)  The division
[department] shall develop an Internet website and printed
materials designed to educate small employers, individuals, and
others seeking to purchase health coverage [the public] about [the
availability of] health coverage in accordance with Section
524.003(a) [in this state, including information about health
savings accounts and compatible high deductible health benefit
plans].
       (b)  The division shall make the printed materials produced
under the program available to small employers, individuals, and
others seeking to purchase health coverage.  The division may:
             (1)  distribute the printed materials through
facilities such as libraries, health care facilities, and schools
as well as other venues the division selects; and
             (2)  use other distribution methods the division
selects.
       (c)  The division may produce a newsletter to provide updated
information about health coverage to subscribers who elect to
receive the newsletter.  The division may:
             (1)  produce a newsletter under this subsection for
small employers, for individuals, or for other purchasers of health
coverage;
             (2)  distribute the newsletter on a monthly, quarterly,
or other basis; and
             (3)  distribute the newsletter as a printed document or
electronically.
       Sec. 524.054.  TOLL-FREE TELEPHONE HOTLINE.  The division
may operate a toll-free telephone hotline or 2-1-1 information line
to respond to inquiries or provide information concerning health
coverage and to provide technical information concerning health
coverage products.
       Sec. 524.055.  EDUCATION FOR HIGH SCHOOL STUDENTS.  (a)  The
division may develop educational materials and a curriculum to be
used in high school economics classes that educate students about:
             (1)  the importance and value of health coverage;
             (2)  comparing health benefit plans; and
             (3)  understanding basic provisions contained in
health benefit plans.
       (b)  The division may consult with the Texas Education Agency
in developing educational materials and a curriculum under this
section.
       Sec. 524.056.  HEALTH COVERAGE FAIRS.  (a)  The division may
conduct health coverage fairs to provide small employers,
individuals, and others seeking to purchase health coverage the
opportunity to obtain information about health coverage from
division employees and from health benefit plan issuers and agents
that elect to participate.
       (b)  The division shall seek to obtain funding for health
coverage fairs conducted under this section through gifts and
grants obtained in accordance with Subchapter D.
       Sec. 524.057.  COMMUNITY EVENTS.  The division may
participate in events held in this state to promote awareness of the
importance and value of health coverage and to educate small
employers, individuals, and others seeking to purchase health
coverage about health coverage in accordance with Section
524.003(a).
       Sec. 524.058.  HEALTH COVERAGE PROVIDED THROUGH COLLEGES AND
UNIVERSITIES.  The division may cooperate with a public or private
college or university to promote enrollment in health coverage
programs sponsored by or through the college or university.
       Sec. 524.059.  SUPPORT FOR COMMUNITY-BASED PROJECTS.  The
division may provide support and assistance to individuals and
organizations seeking to develop community-based health coverage
plans for uninsured individuals.
       Sec. 524.060. OTHER EDUCATION.  The division may [department
shall] provide other appropriate education to the public regarding
health coverage and the importance and value of health coverage in
accordance with Section 524.003(a).
       Sec. 524.061. [524.004.] TASK FORCE.  (a)  The commissioner
may [shall] appoint a task force to make recommendations regarding
the division's duties under this subchapter [health coverage public
awareness and education program]. If appointed, the [The] task
force must be [is] composed of:
             (1)  one representative from each of the following
groups or entities:
                   (A)  health [benefit] coverage consumers;
                   (B)  small employers;
                   (C)  employers generally;
                   (D)  insurance agents;
                   (E)  the office of public insurance counsel;
                   (F)  the Texas Health Insurance Risk Pool;
                   (G)  physicians;
                   (H)  advanced practice nurses;
                   (I)  hospital trade associations; and
                   (J)  medical units of institutions of higher
education;
             (2)  a representative of the Health and Human Services
Commission responsible for programs under Medicaid and the
children's health insurance program; and
             (3)  one or more representatives of health benefit plan
issuers.
       (b)  In addition to the individuals listed in Subsection (a),
the commissioner may select to serve on any task force one or more
individuals with experience in public relations, marketing, or
another related field of professional services.
       (c)  The division may [department shall] consult the task
force regarding the content for the public service announcements,
Internet website, printed materials, and other educational
materials required or authorized by this subchapter [chapter]. The
commissioner has authority to make final decisions as to what the
program's materials will contain.
SUBCHAPTER C.  ASSISTANCE FOR CERTAIN BUSINESSES
       Sec. 524.101.  FEDERAL TAX "TOOL KIT" FOR CERTAIN
BUSINESSES.  The division may:
             (1)  produce materials that:
                   (A)  provide step-by-step instructions for a
small employer or single-employee business that is obtaining health
coverage for the benefit of the employer or business and the
employees of the business; and
                   (B)  are designed to allow the employer or
business to obtain the coverage in a manner that qualifies for
favorable treatment under federal tax laws; and
             (2)  make division staff available to assist small
employers and single-employee businesses that are obtaining health
coverage as described by Subdivision (1).
       Sec. 524.102.  ASSISTANCE FOR SMALL EMPLOYERS AND
SINGLE-EMPLOYEE BUSINESSES.  The division may train staff
concerning available health coverage options for small employers
and single-employee businesses to:
             (1)  respond to telephone inquiries from small
employers and single-employee businesses; and
             (2)  speak at events to provide information about
health coverage options for small employers and single-employee
businesses and about the importance and value of health coverage.
       Sec. 524.103.  COOPERATIVES FOR SMALL EMPLOYERS, LARGE
EMPLOYERS, AND SINGLE-EMPLOYEE BUSINESSES.  The division may
develop a program to assist small employers, large employers, and
single-employee businesses to form or participate in private
purchasing cooperatives and health group cooperatives in
accordance with Subchapter B, Chapter 1501.
       Sec. 524.104.  ACCOUNTANT.  The division may employ an
accountant with experience in federal tax law and the purchase of
group health coverage as necessary to implement this subchapter.
SUBCHAPTER D.  FUNDING
       Sec.  524.151 [524.005].  FUNDING.  The department may
accept gifts and grants from any party, including a health benefit
plan issuer or a foundation associated with a health benefit plan
issuer, to assist with funding the program. The department shall
adopt rules governing acceptance of donations that are consistent
with Chapter 575, Government Code. Before adopting rules under
this section [subsection], the department shall:
             (1)  submit the proposed rules to the Texas Ethics
Commission for review; and
             (2)  consider the commission's recommendations
regarding the regulations.
ARTICLE 2. CHILDREN'S HEALTH BENEFIT PLAN FOR SMALL EMPLOYERS
       SECTION 2.01.  Section 1501.002, Insurance Code, is amended
by adding Subdivision (1-a) and amending Subdivision (15) to read
as follows:
             (1-a)  "Children's health benefit plan" means a health
benefit plan offered in accordance with Section 1501.2525.
             (15)  "Small employer health benefit plan" means a
health benefit plan developed by the commissioner under Subchapter
F or any other health benefit plan offered to a small employer in
accordance with Section 1501.252(c) or 1501.255.  The term includes
a children's health benefit plan.
       SECTION 2.02.  Section 1501.003, Insurance Code, is amended
to read as follows:
       Sec. 1501.003.  APPLICABILITY: SMALL EMPLOYER HEALTH
BENEFIT PLANS.  (a)  An individual or group health benefit plan is a
small employer health benefit plan subject to Subchapters C-H if it
provides health care benefits covering two or more eligible
employees of a small employer and:
             (1)  the employer pays a portion of the premium or
benefits;
             (2)  the employer or a covered individual treats the
health benefit plan as part of a plan or program for purposes of
Section 106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section
106 or 162); or
             (3)  the health benefit plan is an employee welfare
benefit plan under 29 C.F.R. Section 2510.3-1(j).
       (b)  A children's health benefit plan is a small employer
benefit plan subject to Subchapters C, D, and H.  A children's
health benefit plan is not subject to Subchapters E and G.
       SECTION 2.03.  Section 1501.006(a), Insurance Code, is
amended to read as follows:
       (a)  In accordance with rules adopted by the commissioner,
each health benefit plan issuer shall certify that the issuer is
offering, delivering, issuing for delivery, or renewing, or that
the issuer intends to offer, deliver, issue for delivery, or renew:
             (1)  a health benefit plan, other than a children's
health benefit plan, to or through a small employer in this state
that is subject to this chapter; or
             (2)  a health benefit plan to or through a large
employer in this state that is subject to this chapter.
       SECTION 2.04.  Section 1501.101(b), Insurance Code, is
amended to read as follows:
       (b)  A small employer health benefit plan issuer that refuses
to issue a small employer health benefit plan, other than a
children's health benefit plan, in a geographic service area may
not offer a health benefit plan to a small employer in the
applicable service area before the fifth anniversary of the date of
the refusal.
       SECTION 2.05.  Section 1501.108, Insurance Code, is amended
by adding Subsection (d) to read as follows:
       (d)  Subsection (a) does not apply to a children's health
benefit plan.
       SECTION 2.06.  Section 1501.151(a), Insurance Code, is
amended to read as follows:
       (a)  A small employer health benefit plan issuer shall issue
the small employer health benefit plan, other than a children's
health benefit plan, chosen by the small employer to each small
employer that elects to be covered under the plan and agrees to
satisfy the other requirements of the plan.
       SECTION 2.07.  Sections 1501.154(a) and (b), Insurance Code,
are amended to read as follows:
       (a)  Except as provided by Section 1501.155, coverage is
available under a small employer health benefit plan if at least 75
percent of a small employer's eligible employees elect to
participate in the plan.  This subsection does not apply if an
employer offers only a children's health benefit plan.
       (b)  If a small employer offers multiple health benefit
plans, the collective participation in those plans, including any
children's health benefit plan, must be at least:
             (1)  75 percent of the employer's eligible employees;
or
             (2)  if applicable, the lower participation level
offered by the small employer health benefit plan issuer under
Section 1501.155.
       SECTION 2.08.  Subchapter F, Chapter 1501, Insurance Code,
is amended by adding Section 1501.2525 to read as follows:
       Sec. 1501.2525.  CHILDREN'S HEALTH BENEFIT PLAN.  (a)  A
small employer health benefit plan issuer may offer to a small
employer a children's health benefit plan in accordance with this
section.
       (b)  A children's health benefit plan provides coverage to
children younger than 25 years of age:
             (1)  who would otherwise be eligible for coverage under
a small employer health benefit plan offered to an eligible
employee; and
             (2)  whose family income is at or below 400 percent of
the federal poverty level as determined by rules adopted by the
commissioner.
       (c)  A children's health benefit plan may not provide
coverage to an eligible employee or the spouse of an eligible
employee.
       (d)  The commissioner by rule shall adopt minimum benefits
required to be provided under a children's health benefit plan.
       SECTION 2.09.  The commissioner of insurance shall adopt any
rules necessary to implement the change in law made by this article
not later than December 1, 2007.  A small employer health benefit
plan issuer may not offer a children's health benefit plan under
Section 1501.2525, Insurance Code, as added by this article, before
January 1, 2008.
ARTICLE 3.  HEALTH GROUP COOPERATIVES FOR CERTAIN
SINGLE-EMPLOYEE BUSINESSES
       SECTION 3.01.  Section 1501.051, Insurance Code, is amended
by adding Subdivision (3-b) to read as follows:
             (3-b)  "Eligible single-employee business" means a
business entity that:
                   (A)  is owned and operated by a sole proprietor;
                   (B)  employs an average of fewer than two
employees on business days during the preceding calendar year; and
                   (C)  is eligible to participate in a cooperative
under this subchapter in accordance with Section 1501.066.
       SECTION 3.02.  Section 1501.0581, Insurance Code, is amended
by amending Subsections (a), (b), and (p) and adding Subsection
(o-1) 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,
or may consist only of eligible single-employee businesses, but may
not consist of a combination of those types of entities [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 or an eligible single-employee business
as described by Section 1501.066.
       (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 health group
cooperative consisting only of small employers and enroll in health
benefit plan coverage, subject to Subsection (o); [and]
             (2)  may allow an eligible single-employee business to
join a health group cooperative consisting only of eligible
single-employee businesses and enroll in health benefit plan
coverage; and
             (3)  may allow a large employer to join a health group
cooperative consisting only of large employers and enroll in health
benefit plan coverage.
       (o-1)  A health group cooperative consisting only of
eligible single-employee businesses may elect to restrict
membership in the cooperative so that the total number of eligible
employees employed on business days during the preceding calendar
year by all eligible single-employee businesses participating in
the cooperative does not exceed 50.
       (p)  A health group cooperative must make the election
described by Subsection (o) or (o-1) 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 3.03.  Sections 1501.063(b-1) and (b-2), Insurance
Code, are amended to read as follows:
       (b-1)  Subject to Section 1501.066, a [A] health group
cooperative that is composed only of small employers or only of
eligible single-employee businesses and that has made the election
described by Section 1501.0581(o)(1) or (o-1), as applicable, in
accordance with Subsection (p) of that section 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.
       (b-2)  A health group cooperative that is composed only of
small employers or only of eligible single-employee businesses and
that has not made the election described by Section 1501.0581(o)(1)
or (o-1), as applicable, in accordance with Subsection (p) of that
section, or a health group cooperative that is composed only of
large employers, shall be treated in the same manner as a large
employer for the purposes of this chapter, including for the
purposes of any provision relating to premium rates and issuance
and renewal of coverage.
       SECTION 3.04.  Subchapter B, Chapter 1501, Insurance Code,
is amended by adding Section 1501.066 to read as follows:
       Sec. 1501.066.  ELIGIBLE SINGLE-EMPLOYEE BUSINESS.  (a)  The
commissioner by rule shall adopt rules governing the eligibility of
a single-employee business to participate in a health group
cooperative under this subchapter.  The rules must include
provisions to ensure that each eligible single-employee business
has a business purpose and was not formed solely to obtain health
benefit plan coverage under this subchapter.
       (b)  The commissioner may specify additional requirements
for a health group cooperative composed solely of eligible
single-employee businesses to qualify for coverage as a small
employer under this chapter or, if the commissioner finds that
treatment of such a cooperative as a small employer is not
actuarially justified, may require that a health group cooperative
composed solely of eligible single-employee businesses be treated
as a large employer under this chapter.
       SECTION 3.05.  The commissioner of insurance shall adopt any
rules necessary to implement the change in law made by this article
not later than December 1, 2007.  A person may not form a health
group cooperative composed solely of eligible single-employee
businesses under Subchapter B, Chapter 1501, Insurance Code, as
amended by this article, before January 1, 2008.
ARTICLE 4.  SPECIALTY CERTIFICATION FOR CERTAIN LIFE, ACCIDENT, AND
HEALTH AGENTS
       SECTION 4.01.  Chapter 4054, Insurance Code, is amended by
adding Subchapter G to read as follows:
SUBCHAPTER G.  SPECIALTY CERTIFICATION FOR AGENTS SERVING CERTAIN
EMPLOYER GROUPS
       Sec. 4054.301.  CERTIFICATION PROGRAM.  The department shall
establish a voluntary specialty certification program for agents
who market small employer health benefit plans in accordance with
Chapter 1501.
       Sec. 4054.302.  QUALIFICATIONS; FEE.  (a)  To be eligible to
receive a specialty certification under this subchapter, a person
must:
             (1)  hold a general life, accident, and health license
under this chapter;
             (2)  satisfy the requirements of this subchapter;
             (3)  apply to the department in the manner prescribed
by the commissioner; and
             (4)  pay the required application and renewal fees.
       (b)  The department shall set the application and renewal
fees for the specialty certification in the amount necessary to
fund the certification program established by this subchapter, not
to exceed $100. The fees shall be deposited to the credit of the
Texas Department of Insurance operating account.
       Sec. 4054.303.  EXPIRATION AND RENEWAL.  A specialty
certification under this subchapter expires on the third
anniversary of the date of issuance and may be renewed in accordance
with this subchapter and department rule.
       Sec. 4054.304.  TRAINING AND CONTINUING EDUCATION
REQUIREMENTS.  (a)  To be certified under this subchapter, an agent
must complete training in the law, including department rules,
applicable to small employer health benefit plans offered under
Chapter 1501.
       (b)  To renew a specialty certification under this
subchapter, the agent must demonstrate completion of continuing
education requirements during the three-year certification period.
       (c)  The department shall recognize, prepare, or administer
training and continuing education programs for agents who hold a
specialty certification under this subchapter.  The department
shall ensure that the training and continuing education programs
are updated on an ongoing basis to reflect changes in law, including
changes in department rules.
       Sec. 4054.305.  OFFER OF SERVICES TO ALL GROUP SIZES.  To
hold a specialty certification under this subchapter, an agent must
agree to market small employer health benefit plans to small
employers that satisfy the requirements of Chapter 1501 without
regard to the number of employees to be covered under the plan.
       Sec. 4054.306.  ADVERTISING.  An agent who holds a specialty
certification may advertise that the agent is specially trained to
serve small employers in the manner specified by department rule.
       Sec. 4054.307.  LIST MAINTAINED BY DEPARTMENT; WEBSITE. The
department shall maintain a list of all agents who hold a specialty
certification under this chapter, together with the business
address and phone number of each agent and a general description of
the agent's service area. The department shall publish the list on
the department website.
       SECTION 4.02.  To facilitate initial implementation of
Subchapter G, Chapter 4054, Insurance Code, as added by this
article, the Texas Department of Insurance may present during the
12-month period following the effective date of this Act, in
locations throughout the state selected by the department, training
programs that satisfy the requirements of Section 4054.304(a),
Insurance Code, a
s added by this article.
       SECTION 4.03.  Not later than January 1, 2008, the Texas
Department of Insurance may begin issuing specialty certifications
under Subchapter G, Chapter 4054, Insurance Code, as added by this
article.
ARTICLE 5.  EFFECTIVE DATE
       SECTION 5.01.  This Act takes effect September 1, 2007.