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.