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A BILL TO BE ENTITLED
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AN ACT
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relating to the creation of a health insurance risk pool for certain |
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health benefit plan enrollees; authorizing an assessment. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle G, Title 8, Insurance Code, is amended |
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by adding Chapter 1511 to read as follows: |
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CHAPTER 1511. HEALTH INSURANCE RISK POOL |
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Sec. 1511.001. DEFINITION. In this chapter, "pool" means a |
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health insurance risk pool established and administered by the |
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commissioner under this chapter. |
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Sec. 1511.002. ESTABLISHMENT OF HEALTH INSURANCE RISK POOL. |
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To the extent that federal funds are available, the commissioner |
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may: |
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(1) apply for the federal funds; and |
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(2) use the federal funds to establish and administer |
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a pool for the purpose of this chapter. |
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Sec. 1511.003. PURPOSE OF POOL. (a) The purpose of the |
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pool is to provide a mechanism to meaningfully reduce health |
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insurance premiums in the individual health insurance market by |
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maximizing available federal funds to assist residents of this |
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state to obtain guaranteed issue health benefit coverage. |
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(b) The pool may not be used to expand the Medicaid program, |
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including the program administered under Chapter 32, Human |
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Resources Code, and the program administered under Chapter 533, |
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Government Code. |
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Sec. 1511.004. METHODS TO REDUCE PREMIUM IN THE INDIVIDUAL |
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MARKET. Subject to any requirements to obtain federal funds for the |
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pool, the commissioner may use money from the pool to achieve lower |
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enrollee premium rates by providing to health benefit plan issuers |
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writing guaranteed issue coverage in the individual market: |
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(1) a reinsurance program; or |
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(2) direct funding if the health benefit plan issuer's |
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plan provides coverage for individuals described by Section |
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1511.005. |
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Sec. 1511.005. ACCESS TO GUARANTEED ISSUE COVERAGE. The |
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commissioner shall use pool funds to enhance enrollment in |
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guaranteed issue coverage in the individual market in a manner that |
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ensures that the benefits and cost-sharing protections available in |
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the individual market are maintained in the same manner the |
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benefits and protections would be maintained without the waiver |
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described by Section 1511.020. |
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Sec. 1511.006. CONTRACTS AND AGREEMENTS. The commissioner |
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may enter into a contract or agreement that the commissioner |
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determines is appropriate to carry out this chapter, including a |
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contract or agreement with: |
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(1) a similar pool in another state for the joint |
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performance of common administrative functions; |
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(2) another organization for the performance of |
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administrative functions; or |
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(3) a federal agency. |
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Sec. 1511.007. FUNDING. (a) The commissioner may use funds |
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appropriated to the department to: |
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(1) apply for federal funds and grants; and |
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(2) administer this chapter. |
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(b) Notwithstanding Section 6(e)(2)(B), Chapter 615 (S.B. |
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1367), Acts of the 83rd Legislature, Regular Session, 2013, the |
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commissioner may use money appropriated to the department from the |
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healthy Texas small employer premium stabilization fund for the |
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exclusive purposes of this chapter, other than for paying salaries |
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and salary-related benefits. |
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(c) Notwithstanding Section 6(e)(2)(B), Chapter 615 (S.B. |
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1367), Acts of the 83rd Legislature, Regular Session, 2013, the |
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commissioner shall transfer money from the healthy Texas small |
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employer premium stabilization fund to the Texas Department of |
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Insurance operating account in an amount equal to the amount of |
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money appropriated to the department from that fund, as described |
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by Subsection (b), for the direct and indirect costs of the |
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exclusive purposes of this chapter. |
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(d) Except as provided by Subsections (a) and (b), the |
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commissioner may not use any state funds to fund the pool unless the |
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funds are specifically appropriated for that purpose. |
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Sec. 1511.008. ASSESSMENTS. (a) The commissioner may |
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assess health benefit plan issuers, including making advance |
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interim assessments, as reasonable and necessary for the pool's |
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organizational and interim operating expenses. |
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(b) The commissioner shall credit an interim assessment as |
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an offset against any regular assessment that is due after the end |
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of the fiscal year. |
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(c) The regular assessment is the amount determined by the |
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commissioner under Section 1511.009 and recovered from health |
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benefit plan issuers under Section 1511.013. |
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Sec. 1511.009. DETERMINATION OF POOL FUNDING REQUIREMENTS. |
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After the end of each fiscal year, the commissioner shall determine |
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for the next calendar year the amount of money required by the pool |
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to reduce the amount of premiums the enrollee would otherwise pay in |
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that year by 15 percent in accordance with this chapter after |
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applying the federal funds obtained under this chapter. |
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Sec. 1511.010. ANNUAL REPORT TO COMMISSIONER. Each health |
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benefit plan issuer shall report to the commissioner the |
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information requested by the commissioner, as of December 31 of the |
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preceding year. |
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Sec. 1511.011. ANNUAL REPORT TO COMMISSIONER: ENROLLED |
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INDIVIDUALS. (a) Each health benefit plan issuer shall report to |
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the commissioner the number of residents of this state enrolled, as |
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of December 31 of the previous year, in the issuer's health benefit |
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plans providing coverage for residents in this state, as: |
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(1) an employee under a group health benefit plan; or |
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(2) an individual policyholder or subscriber. |
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(b) In determining the number of individuals to report under |
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Subsection (a)(1), the health benefit plan issuer shall include |
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each employee for whom a premium is paid and coverage is provided |
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under an excess loss, stop-loss, or reinsurance policy issued by |
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the issuer to an employer or group health benefit plan providing |
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coverage for employees in this state. A health benefit plan issuer |
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providing excess loss insurance, stop-loss insurance, or |
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reinsurance, as described by this subsection, for a primary health |
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benefit plan issuer may not report individuals reported by the |
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primary health benefit plan issuer. |
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(c) Ten employees covered by a health plan issuer under a |
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policy of excess loss insurance, stop-loss insurance, or |
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reinsurance count as one employee for purposes of determining that |
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health plan issuer's assessment. |
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(d) In determining the number of individuals to report under |
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this section, the health benefit plan issuer shall exclude: |
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(1) the dependents of the employee or an individual |
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policyholder or subscriber; and |
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(2) individuals who are covered by the health benefit |
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plan issuer under a Medicare supplement benefit plan subject to |
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Chapter 1652. |
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(e) In determining the number of enrolled individuals to |
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report under this section, the health benefit plan issuer shall |
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exclude individuals who are retired employees 65 years of age or |
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older. |
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Sec. 1511.012. ANNUAL REPORT TO COMMISSIONER: GROSS |
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PREMIUMS. (a) Each health benefit plan issuer shall report to the |
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commissioner the gross premiums collected for the preceding |
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calendar year for health benefit plans. |
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(b) For purposes of this section, gross health benefit plan |
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premiums do not include premiums collected for: |
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(1) coverage under a Medicare supplement benefit plan |
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subject to Chapter 1652; |
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(2) coverage under a small employer health benefit |
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plan subject to Chapter 1501; |
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(3) coverage: |
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(A) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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accident or disability; |
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(B) as a supplement to a liability insurance |
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policy; |
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(C) for credit insurance; |
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(D) only for dental or vision care; |
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(E) only for a specified disease or illness; or |
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(F) only for indemnity for hospital confinement; |
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(4) a workers' compensation insurance policy; |
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(5) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; |
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(6) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides comprehensive health benefit plan coverage; |
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(7) liability insurance coverage, including general |
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liability insurance and automobile liability insurance; |
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(8) coverage for on-site medical clinics; |
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(9) insurance coverage under which benefits are |
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payable with or without regard to fault and that is statutorily |
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required to be contained in a liability insurance policy or |
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equivalent self-insurance; or |
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(10) other similar insurance coverage, as specified by |
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federal regulations issued under the Health Insurance Portability |
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and Accountability Act of 1996 (Pub. L. No. 104-191), under which |
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benefits for medical care are secondary or incidental to other |
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insurance benefits. |
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Sec. 1511.013. ASSESSMENTS TO COVER POOL FUNDING |
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REQUIREMENTS. (a) The commissioner shall recover an amount equal |
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to the funding required as estimated under Section 1511.009 by |
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assessing each health benefit plan issuer an amount determined |
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annually by the commissioner based on information in annual |
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statements, the health benefit plan issuer's annual report to the |
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commissioner under Sections 1511.010 and 1511.011, and any other |
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reports required by and filed with the commissioner. |
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(b) The commissioner shall use the total number of enrolled |
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individuals reported by all health benefit plan issuers under |
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Section 1511.011 as of the preceding December 31 to compute the |
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amount of a health benefit plan issuer's assessment, if any, in |
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accordance with this subsection. The commissioner shall allocate |
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the total amount to be assessed based on the total number of |
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enrolled individuals covered by excess loss, stop-loss, or |
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reinsurance policies and on the total number of other enrolled |
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individuals as determined under Section 1511.011. To compute the |
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amount of a health benefit plan issuer's assessment: |
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(1) for the issuer's enrolled individuals covered by |
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an excess loss, stop-loss, or reinsurance policy, the commissioner |
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shall: |
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(A) divide the allocated amount to be assessed by |
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the total number of enrolled individuals covered by excess loss, |
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stop-loss, or reinsurance policies, as determined under Section |
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1511.011, to determine the per capita amount; and |
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(B) multiply the number of a health benefit plan |
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issuer's enrolled individuals covered by an excess loss, stop-loss, |
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or reinsurance policy, as determined under Section 1511.011, by the |
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per capita amount to determine the amount assessed to that health |
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benefit plan issuer; and |
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(2) for the issuer's enrolled individuals not covered |
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by excess loss, stop-loss, or reinsurance policies, the |
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commissioner, using the gross health benefit plan premiums reported |
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for the preceding calendar year by health benefit plan issuers |
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under Section 1511.012, shall: |
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(A) divide the gross premium collected by a |
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health benefit plan issuer by the gross premium collected by all |
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health benefit plan issuers; and |
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(B) multiply the allocated amount to be assessed |
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by the fraction computed under Paragraph (A) to determine the |
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amount assessed to that health benefit plan issuer. |
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(c) A small employer health benefit plan subject to Chapter |
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1501 is not subject to an assessment under this section. |
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Sec. 1511.014. ASSESSMENT DUE DATE; INTEREST. (a) An |
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assessment is due on the date specified by the commissioner that is |
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not earlier than the 30th day after the date written notice of the |
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assessment is transmitted to the health benefit plan issuer. |
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(b) Interest accrues on the unpaid amount of an assessment |
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at a rate equal to the prime lending rate, as published in the most |
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recent issue of the Wall Street Journal and determined as of the |
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first day of each month during which the assessment is delinquent, |
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plus three percent. |
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Sec. 1511.015. ABATEMENT OR DEFERMENT OF ASSESSMENT. (a) A |
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health benefit plan issuer may petition the commissioner for an |
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abatement or deferment of all or part of an assessment imposed by |
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the commissioner. The commissioner may abate or defer all or part |
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of the assessment if the commissioner determines that payment of |
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the assessment would endanger the ability of the health benefit |
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plan issuer to fulfill its contractual obligations. |
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(b) If all or part of an assessment against a health benefit |
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plan issuer is abated or deferred, the amount of the abatement or |
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deferment shall be assessed against the other health benefit plan |
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issuers in a manner consistent with the method for computing |
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assessments under this chapter. |
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(c) A health benefit plan issuer receiving an abatement or |
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deferment under this section remains liable to the pool for the |
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deficiency. |
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Sec. 1511.016. USE OF EXCESS FROM ASSESSMENTS. If the total |
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amount of the assessments exceeds the pool's actual losses and |
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administrative expenses, the commissioner shall credit each health |
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benefit plan issuer with the excess in an amount proportionate to |
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the amount the health benefit plan issuer paid in assessments. The |
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credit may be paid to the health benefit plan issuer or applied to |
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future assessments under this chapter. |
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Sec. 1511.017. COLLECTION OF ASSESSMENTS. The pool may |
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recover or collect assessments made under this chapter. |
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Sec. 1511.018. PROCEDURES, CRITERIA, AND FORMS. The |
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commissioner by rule shall provide the procedures, criteria, and |
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forms necessary to implement, collect, and deposit assessments |
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under this chapter. |
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Sec. 1511.019. PUBLIC EDUCATION AND OUTREACH. (a) The |
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commissioner may use funds appropriated to the department for the |
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exclusive purposes of this chapter to develop and implement public |
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education, outreach, and facilitated enrollment strategies under |
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this chapter. |
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(b) The commissioner may contract with marketing |
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organizations to perform or provide assistance with the strategies |
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described by Subsection (a). |
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Sec. 1511.020. WAIVER. The commissioner may: |
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(1) apply to the United States secretary of health and |
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human services under 42 U.S.C. Section 18052 for a waiver of |
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applicable provisions of the Patient Protection and Affordable Care |
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Act (Pub. L. No. 111-148) and any applicable regulations or |
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guidance; |
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(2) take any action the commissioner considers |
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appropriate to make an application under Subdivision (1); and |
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(3) implement a state plan that meets the requirements |
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of a waiver granted in response to an application under Subdivision |
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(1) if the plan is: |
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(A) consistent with state and federal law; and |
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(B) approved by the United States secretary of |
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health and human services. |
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Sec. 1511.021. AUTHORITY TO ACT AS REINSURER. In addition |
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to the powers granted to the commissioner under this chapter, the |
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commissioner may exercise any authority that may be exercised under |
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the law of this state by a reinsurer. |
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Sec. 1511.022. RULES. The commissioner may adopt rules |
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necessary to implement this chapter, including rules to administer |
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the pool and distribute money from the pool. |
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Sec. 1511.023. EXEMPTION FROM STATE TAXES AND FEES. |
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Notwithstanding any other law, a program created under this chapter |
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is not subject to any state tax, regulatory fee, or surcharge, |
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including a premium or maintenance tax or fee. |
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Sec. 1511.024. ANNUAL REPORT OF POOL ACTIVITIES. (a) |
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Beginning June 1, 2020, not later than June 1 of each year, the |
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department shall submit a report to the governor, the lieutenant |
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governor, and the speaker of the house of representatives. |
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(b) The report submitted under Subsection (a) must |
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summarize the activities conducted under this chapter in the |
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calendar year preceding the year in which the report is submitted. |
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SECTION 2. Notwithstanding Section 6(d)(2), Chapter 615 |
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(S.B. 1367), Acts of the 83rd Legislature, Regular Session, 2013, |
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on the effective date of this Act, the commissioner of insurance |
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shall transfer any money remaining outside the state treasury in |
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the Texas Treasury Safekeeping Trust Company account established |
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under Section 6(c), Chapter 615 (S.B. 1367), Acts of the 83rd |
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Legislature, Regular Session, 2013, to the health insurance risk |
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pool established by Chapter 1511, Insurance Code, as added by this |
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Act. |
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SECTION 3. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2019. |