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A BILL TO BE ENTITLED
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AN ACT
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relating to regulation of health care cost-sharing organizations. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Subtitle K, Title 8, Insurance |
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Code, is amended to read as follows: |
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SUBTITLE K. HEALTH CARE COST SHARING [MINISTRIES] |
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SECTION 2. Subtitle K, Title 8, Insurance Code, is amended |
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by adding Chapter 1682 to read as follows: |
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CHAPTER 1682. HEALTH CARE COST-SHARING ORGANIZATIONS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 1682.0001. DEFINITIONS. In this chapter: |
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(1) "Health care cost-sharing organization" means an |
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entity that facilitates the sharing of health care expenses among |
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the entity's participants. The term does not include a health |
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benefit plan issuer or a health care sharing ministry described by |
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Section 1681.001. |
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(2) "Participant" means an individual enrolled in a |
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health care cost-sharing organization to voluntarily share health |
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care expenses with other individuals enrolled in the organization. |
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Sec. 1682.0002. EXEMPTION. Notwithstanding any other |
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provision of this code, a health care cost-sharing organization |
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that acts in accordance with this chapter is not considered to be |
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engaging in the business of insurance. |
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Sec. 1682.0003. CONSTRUCTION OF CHAPTER. This chapter may |
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not be construed to assign responsibility for a person's health |
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care expenses to any other person. |
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SUBCHAPTER B. REGULATION OF HEALTH CARE COST-SHARING ORGANIZATIONS |
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Sec. 1682.0051. HEALTH CARE COST SHARING. (a) A health care |
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cost-sharing organization shall facilitate health care cost |
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sharing among its participants by matching participants with health |
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care bills to participants with the ability to provide financial |
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assistance in accordance with the criteria established by the |
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organization. |
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(b) In facilitating health care cost sharing, a health care |
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cost-sharing organization: |
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(1) shall collect resources from participants to |
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provide payments for a participant's health care bills through the |
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direct contributions from one participant to another without the |
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pooling of accounts; and |
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(2) may not have a financial interest in a |
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participant's decision on whether to share money. |
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Sec. 1682.0052. COMMUNITY MAINTENANCE. A health care |
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cost-sharing organization may suggest an amount that participants |
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may voluntarily contribute to community maintenance. The |
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organization may not require a participant to make a contribution |
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or assume a risk for the community maintenance. |
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Sec. 1682.0053. REQUIRED DISCLOSURES. (a) A health care |
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cost-sharing organization shall provide the following written |
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disclosure to prospective participants and annually to |
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participants: |
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"Health care cost-sharing organizations facilitate the |
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sharing of health care expenses but are not insurance companies. |
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Neither their guidelines nor their plans of operation are an |
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insurance policy. Whether anyone chooses to assist you with your |
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health care bills will be totally voluntary because no other |
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participant will be compelled by law to contribute toward your |
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health care bills. |
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"As such, participation in the cost-sharing coverage or a |
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subscription to any of its documents should never be considered to |
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be or treated like insurance. Regardless of whether you receive any |
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payment for health care expenses or whether this organization |
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continues to operate, you are always personally responsible for the |
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payment of your own health care bills. Complaints concerning any |
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health care cost-sharing organization may be reported to the office |
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of the Texas attorney general." |
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(b) A health care cost-sharing organization shall provide a |
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written disclosure of all administrative fees and costs to |
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prospective participants and annually to participants. |
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Sec. 1682.0054. MONTHLY STATEMENT. A health care |
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cost-sharing organization shall provide a written monthly |
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statement to all participants that lists: |
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(1) the total dollar amount of qualified needs |
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submitted to the organization; and |
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(2) the amount actually published or assigned to |
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participants for their contribution. |
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Sec. 1682.0055. PARTICIPANT CARD. A health care |
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cost-sharing organization shall ensure that a card issued to a |
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participant for the purpose of presentation to a health care |
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provider clearly indicates that the participant is part of a health |
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care cost-sharing organization that is not engaging in the business |
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of insurance. |
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Sec. 1682.0056. DISCOUNT HEALTH CARE PROGRAM PROHIBITED. A |
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health care cost-sharing organization may not operate a discount |
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health care program as defined by Section 7001.001. |
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Sec. 1682.0057. COMPLAINT; INJUNCTION. (a) A person who |
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reasonably believes that a health care cost-sharing organization is |
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not complying with this chapter may file a written complaint with |
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the attorney general. |
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(b) The attorney general may investigate a complaint |
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received under Subsection (a). If the attorney general determines |
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that a violation has occurred, the attorney general may bring a |
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civil action in the name of the state for an injunction against a |
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health care cost-sharing organization that is violating this |
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chapter. |
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SECTION 3. This Act takes effect September 1, 2021. |