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A BILL TO BE ENTITLED
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AN ACT
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relating to who is an employee for large and small employers for |
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health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Sections 1501.002(8), (13), and (14), Insurance |
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Code, are amended to read as follows: |
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(8) "Large employer" means a person who employed an |
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average of at least 51 [eligible] employees on business days during |
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the preceding calendar year and who employs at least two employees |
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on the first day of the plan year. The term includes a governmental |
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entity subject to Article 3.51-1, 3.51-4, or 3.51-5, to Subchapter |
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C, Chapter 1364, to Chapter 1578, or to Chapter 177, Local |
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Government Code, that otherwise meets the requirements of this |
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subdivision. For purposes of this definition, a partnership is the |
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employer of a partner. |
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(13) "Premium" means all amounts paid by a small or |
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large employer and [eligible] employees as a condition of receiving |
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coverage from a small or large employer health benefit plan issuer, |
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including any fees or other contributions associated with a health |
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benefit plan. |
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(14) "Small employer" means a person who employed an |
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average of at least two employees but not more than 50 [eligible] |
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employees on business days during the preceding calendar year and |
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who employs at least two employees on the first day of the plan |
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year. The term includes a governmental entity subject to Article |
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3.51-1, 3.51-4, or 3.51-5, to Subchapter C, Chapter 1364, to |
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Chapter 1578, or to Chapter 177, Local Government Code, that |
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otherwise meets the requirements of this subdivision. For |
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purposes of this definition, a partnership is the employer of a |
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partner. |
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SECTION 2. Section 1501.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1501.003. APPLICABILITY: SMALL EMPLOYER HEALTH |
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BENEFIT PLANS. An individual or group health benefit plan is a |
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small employer health benefit plan subject to Subchapters C-H if it |
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provides health care benefits covering two or more [eligible] |
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employees of a small employer and: |
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(1) the employer pays a portion of the premium or |
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benefits; |
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(2) the employer or a covered individual treats the |
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health benefit plan as part of a plan or program for purposes of |
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Section 106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section |
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106 or 162); or |
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(3) the health benefit plan is an employee welfare |
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benefit plan under 29 C.F.R. Section 2510.3-1(j). |
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SECTION 3. Section 1501.004, Insurance Code, is amended to |
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read as follows: |
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Sec. 1501.004. APPLICABILITY: LARGE EMPLOYER HEALTH |
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BENEFIT PLANS. An individual or group health benefit plan is a |
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large employer health benefit plan subject to Subchapters C and M if |
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the plan provides health care benefits to [eligible] employees of a |
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large employer and: |
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(1) the employer pays a portion of the premium or |
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benefits; |
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(2) the employer or a covered individual treats the |
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health benefit plan as part of a plan or program for purposes of |
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Section 106 or 162, Internal Revenue Code of 1986 (26 U.S.C. Section |
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106 or 162); or |
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(3) the health benefit plan is an employee welfare |
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benefit plan under 29 C.F.R. Section 2510.3-1(j). |
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SECTION 4. Section 1501.009(a), Insurance Code, is amended |
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to read as follows: |
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(a) An independent school district may elect to participate |
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as a small employer without regard to the number of [eligible] |
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employees in the district. An independent school district that |
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makes the election is treated as a small employer under this chapter |
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for all purposes. |
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SECTION 5. Sections 1501.011(a) and (b), Insurance Code, |
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are amended to read as follows: |
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(a) For an employer that did not exist throughout the |
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calendar year preceding the year in which the determination of |
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whether the employer is a small employer is made, the determination |
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is based on the average number of employees [and eligible
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employees] the employer reasonably expects to employ on business |
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days in the calendar year in which the determination is made. |
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(b) For an employer that did not exist throughout the |
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calendar year preceding the year in which the determination of |
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whether the employer is a large employer is made, the determination |
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is based on the average number of [eligible] employees the employer |
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reasonably expects to employ on business days in the calendar year |
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in which the determination is made. |
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SECTION 6. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2014. A plan that is delivered, issued for |
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delivery, or renewed before January 1, 2014, is governed by the law |
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in effect immediately before the effective date of this Act, and |
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that law continues in effect for that purpose. |
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SECTION 7. This Act takes effect September 1, 2013. |