81R10542 KCR-D

By: Martinez H.B. No. 2881

A BILL TO BE ENTITLED

AN ACT

relating to the establishment of the Texas Affordable Health Care Benefit Program.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle G, Title 8, Insurance Code, is amended by adding Chapter 1536 to read as follows:

CHAPTER 1536. TEXAS AFFORDABLE HEALTH CARE BENEFIT PROGRAM

SUBCHAPTER A. GENERAL PROVISIONS

Sec. 1536.001. APPLICABILITY OF CHAPTER. This chapter applies only to an entity authorized to issue an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter 842;

(3) a fraternal benefit society operating under Chapter 885;

(4) a stipulated premium company operating under Chapter 884;

(5) a reciprocal exchange operating under Chapter 942;

(6) a Lloyd's plan operating under Chapter 941;

(7) a health maintenance organization operating under Chapter 843;

(8) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or

(9) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.

Sec. 1536.002. DEFINITIONS. In this chapter:

(1) "Health benefit plan issuer" means an entity described by Section 1536.001.

(2) "Program" means the Texas Affordable Health Care Benefit Program established under Subchapter B.

Sec. 1536.003. CERTAIN EMPLOYER ACTIONS PROHIBITED. An employer in this state that offers health benefit plan coverage to employees may not:

(1) cease to offer health benefit coverage only to individuals who are otherwise eligible to purchase health benefit plan coverage under the program; or

(2) require employees who are eligible to purchase health benefit plan coverage under the program to purchase that coverage.

Sec. 1536.004. RULES. The commissioner shall adopt rules as necessary to implement this chapter.

[Sections 1536.005-1536.050 reserved for expansion]

SUBCHAPTER B. PROGRAM ESTABLISHMENT AND REQUIREMENTS

Sec. 1536.051. PROGRAM ESTABLISHMENT; FUNDING. (a) The department shall establish the Texas Affordable Health Care Benefit Program to provide affordable health benefit plan coverage in this state.

(b) Each health benefit plan issuer in this state shall participate in the program.

(c) The program is funded through assessments levied by the commissioner under Subchapter C.

Sec. 1536.052. APPLICATION PROCESS. (a) The department shall develop a procedure through which individuals and families may apply for health benefit plan coverage under the program.

(b) The application procedure developed under Subsection (a) must include:

(1) an Internet website that provides comparative information concerning the premiums for and levels of coverage provided under health benefit plans issued under the program; and

(2) a process through which a hospital or other institutional health care provider:

(A) may assist an individual in applying to purchase health benefit plan coverage under the program; and

(B) at the time of application, receive a precertification or preauthorization to treat the patient under the terms of the health benefit plan for which the patient has applied.

Sec. 1536.053. ELIGIBILITY TO PURCHASE COVERAGE. (a) Subject to Subsection (b), the following individuals may purchase health benefit plan coverage under the program:

(1) each member of a family with a household annual income of $100,000 or less who is not eligible for coverage under a health benefit plan issued, sponsored, or paid for by an employer of a member of the family and has not been eligible for that coverage in the 12 months immediately preceding the date of application for coverage issued under the program; and

(2) an individual other than an individual described by Subdivision (1) who has an annual income of $55,000 or less and is not eligible for coverage under a health benefit plan issued, sponsored, or paid for by an employer and has not been eligible for that coverage in the 12 months immediately preceding the date of application for coverage issued under the program.

(b) An individual who is eligible for health benefit coverage under Medicaid or a program operated by the United States Department of Veterans Affairs may not purchase health benefit plan coverage under the program.

Sec. 1536.054. PREMIUMS. (a) The commissioner by rule shall establish a sliding scale for premiums to be charged by health benefit plan issuers for health benefit plan coverage under the program.

(b) The sliding scale established under Subsection (a):

(1) subject to Subdivision (2), must require an individual or family to pay not less than $20 per month per person and not more than $100 per month per person for health benefit plan coverage under the program; and

(2) must provide a maximum aggregated premium of $400 per month per family.

Sec. 1536.055. POLICY PERIOD. The policy period for a health benefit plan issued under the program is one year.

Sec. 1536.056. DEDUCTIBLES AND COPAYMENTS. (a) A health benefit plan issued under the program may not have an annual deductible that exceeds $1,000.

(b) A health benefit plan issued under the program may not have copayments that exceed $20 per person per visit.

Sec. 1536.057. REQUIRED COVERAGE. A health benefit plan issued under the program must provide coverage:

(1) for prescription drugs in a manner that complies with Chapter 1369; and

(2) at a level that is equal to or greater than the level of coverage provided under a health plan issued under Chapter 62, Health and Safety Code.

[Sections 1536.058-1536.100 reserved for expansion]

SUBCHAPTER C. ASSESSMENTS

Sec. 1536.101. ANNUAL REPORT TO DEPARTMENT. On September 1 of each calendar year, a health benefit plan issuer shall report to the department:

(1) the number of individuals covered under a health benefit plan issued by the issuer under the program during the period beginning on September 1 of the previous calendar year and ending on August 31 of the calendar year in which the report is made; and

(2) the gross premiums collected by the health benefit plan issuer for health benefit plans issued under the program during the period described by Subdivision (1).

Sec. 1536.102. ASSESSMENT. (a) The commissioner shall assess a health benefit plan issuer an amount that is equal to one percent of the gross premiums collected by the health benefit plan issuer for health benefit plans issued under the program, as reported by the health benefit plan issuer under Section 1536.101(2).

(b) The commissioner may levy assessments in addition to those required under Subsection (a) as necessary to fully fund the operation of the program. An assessment levied against a health benefit plan issuer under this subsection must be proportional to the number of health benefit plans written by the issuer under the program to the total number of health benefit plans issued under the program.

(c) A health benefit plan issuer may pay assessments made under this section in equal monthly installments or in a lump sum on a date determined by the commissioner by rule.

Sec. 1536.103. USE OF ASSESSMENT. Assessments paid and collected under this subchapter may be used only to:

(1) fund the operation of the program; and

(2) reimburse health benefit plan issuers for any losses incurred as a direct result of participating in the program.

SECTION 2. The Texas Department of Insurance shall ensure that the Texas Affordable Health Care Benefit Program described by Chapter 1536, Insurance Code, as added by this Act, is fully operational not later than September 1, 2010.

SECTION 3. This Act takes effect September 1, 2009.