87R5029 SMT-D
 
  By: Israel H.B. No. 2761
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to disclosure requirements for accident and health
  coverage and health expense arrangements marketed to individuals.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle A, Title 8, Insurance Code, is amended
  by adding Chapter 1223 to read as follows:
  CHAPTER 1223. MANDATORY DISCLOSURES FOR ALTERNATIVE HEALTH
  COVERAGE AND HEALTH EXPENSE ARRANGEMENTS
  SUBCHAPTER A. GENERAL PROVISIONS
         Sec. 1223.001.  DEFINITION. In this chapter, "issuer" means
  a person who markets, sells, issues, or operates an individual
  health benefit plan or health expense arrangement governed by this
  chapter. 
         Sec. 1223.002.  APPLICABILITY. Except as provided by
  Section 1223.003 but notwithstanding any other law, this chapter
  applies to a health benefit plan or health expense arrangement
  marketed to an individual to provide health benefit coverage or pay
  for health care expenses, including:
               (1)  an individual accident and health insurance policy
  governed by Chapter 1201;
               (2)  a group accident and health insurance policy
  governed by Chapter 1251 that is marketed to an individual; 
               (3)  individual health maintenance organization
  coverage;
               (4)  a health care sharing ministry operated under
  Chapter 1681;
               (5)  a discount health care program governed by Chapter
  7001;
               (6)  a direct primary care arrangement governed by
  Subchapter F, Chapter 162, Occupations Code; or
               (7)  any other plan or arrangement the commissioner
  determines is or could be marketed to an individual as an
  alternative or supplement to an employer-provided health benefit
  plan or health benefit plan coverage regulated under the Patient
  Protection and Affordable Care Act (Pub. L. No. 111-148). 
         Sec. 1223.003.  EXCEPTION. This chapter does not apply to a
  health benefit plan or health expense arrangement if:
               (1)  the issuer is required to submit a summary of
  benefits and coverage for the plan or arrangement to the United
  States secretary of health and human services under 42 U.S.C. Sec.
  300gg-15; or
               (2)  the issuer is required to provide a disclosure
  form for the plan or arrangement under Section 1509.002. 
         Sec. 1223.004.  RULES. The commissioner may adopt rules
  necessary to implement this chapter.
  SUBCHAPTER B. DISCLOSURE REQUIRED
         Sec. 1223.051.  DISCLOSURE FORM TEMPLATE. (a) The
  commissioner by rule shall prescribe a disclosure form template for
  each type of health benefit plan or health expense arrangement to
  which this chapter applies. 
         (b)  The commissioner shall ensure that the disclosure form
  template is presented in plain language and in a standardized
  format designed to facilitate consumer understanding. 
         (c)  The commissioner may prescribe as many disclosure form
  templates as necessary to account for each type of health benefit
  plan or health expense arrangement. 
         (d)  Except as provided by Subsection (e), the disclosure
  form template must include the following information that is
  tailored to the type of health benefit plan or health expense
  arrangement described by the template:
               (1)  a statement:
                     (A)  of whether the plan or arrangement is
  insurance; and
                     (B)  of what, if any, guarantees are made of
  payment for health care services;
               (2)  the duration of coverage;
               (3)  a statement:
                     (A)  of whether:
                           (i)  the plan or arrangement may be renewed
  at the option of the enrollee or participant with no new
  underwriting;
                           (ii)  the plan or arrangement is only able to
  be renewed at the option of the issuer after underwriting; or
                           (iii)  the plan or arrangement may not be
  renewed;
                     (B)  of whether, on renewal, the issuer is able
  to:
                           (i)  increase the premium or assess a direct
  fee, contribution, or similar cost; or
                           (ii)  make changes to the plan or
  arrangement terms, including benefits and limits, based on an
  individual's health status;
                     (C)  that the expiration of the plan or
  arrangement is not a qualifying life event that would make a person
  eligible for a special enrollment period, if applicable; and 
                     (D)  that the plan or arrangement may expire
  outside of the open enrollment period under the Patient Protection
  and Affordable Care Act (Pub. L. No. 111-148);
               (4)  to the extent the information is available, the
  dates of the next three open enrollment periods under the Patient
  Protection and Affordable Care Act (Pub. L. No. 111-148) following
  the date the plan or arrangement expires;
               (5)  whether the plan or arrangement contains any
  limitations or exclusions to preexisting conditions;
               (6)  the maximum dollar amount payable under the plan
  or arrangement;
               (7)  the deductibles under the plan or arrangement and
  the health care services to which the deductibles apply;
               (8)  whether the following health care services are
  covered and any limits to the coverage:
                     (A)  prescription drugs;
                     (B)  mental health services;
                     (C)  substance abuse treatment;
                     (D)  maternity care;
                     (E)  hospitalization;
                     (F)  surgery;
                     (G)  emergency health care; and
                     (H)  preventive health care;
               (9)  for a plan or arrangement other than a
  traditional, major medical health benefit plan, information on
  unique aspects of the plan or arrangement and how it differs from
  traditional, major medical coverage that the commissioner
  determines is important to facilitate consumer understanding; and
               (10)  any other information the commissioner
  determines is important for a purchaser or participant of a plan or
  arrangement. 
         (e)  The commissioner may omit information described by
  Subsection (d) in a disclosure form template if the information is
  inapplicable to the type of plan or arrangement for which the
  template is prescribed.
         Sec. 1223.052.  DISCLOSURE FORM REVIEW. (a) Before an
  issuer may sell, market, or provide a health benefit plan or health
  expense arrangement to a consumer, the issuer shall submit to the
  department for approval in the manner prescribed by department rule
  a disclosure form for each plan or arrangement offered by the
  issuer.
         (b)  Except as provided by Subsection (c), the disclosure
  form must use the disclosure form template prescribed by the
  commissioner under Section 1223.051 for the health benefit plan or
  health expense arrangement described by the form.
         (c)  An issuer may modify the disclosure form template for a
  health benefit plan or health expense arrangement that is not able
  to be accurately represented by the template. If the issuer
  modifies the template, the issuer shall clearly identify any
  changes made and explain the reason for those changes when the
  issuer submits the form for approval under Subsection (a).
         (d)  The department shall approve a disclosure form if the
  form uses the appropriate disclosure form template and accurately
  describes the health benefit plan or health expense arrangement in
  a manner that is easily understandable to a consumer.
         Sec. 1223.053.  DISCLOSURE TO CONSUMER. (a) An issuer shall
  provide to a consumer the disclosure form approved under Section
  1223.052:
               (1)  before the earliest of the time that the consumer
  completes an application, makes an initial premium payment, or
  makes any other payment in connection with coverage under or
  participation in the health benefit plan or health expense
  arrangement; and
               (2)  at the time the policy, certificate, or
  arrangement is issued or entered into.
         (b)  An issuer shall ensure that a consumer signs the
  disclosure form before the issuer accepts an application or
  payment for or issues or enters into the health benefit plan or
  health expense arrangement. An electronic signature must comply
  with Chapter 35 and rules adopted under this chapter.
         Sec. 1223.054.  RETENTION. An issuer shall retain a signed
  disclosure form until the fifth anniversary of the date the issuer
  receives the form, and the issuer shall make the form available to
  the department on request. 
         Sec. 1223.055.  HEALTH CARE SHARING MINISTRIES. The
  commissioner shall consult with the attorney general in prescribing
  the disclosure form template applicable to a health care sharing
  ministry, and the template must incorporate the notice described by
  Section 1681.002.
         Sec. 1223.056.  DIRECT PRIMARY CARE ARRANGEMENTS. The
  commissioner shall consult with the Texas Medical Board in
  prescribing the disclosure form template applicable to a direct
  primary care arrangement, and the template must incorporate the
  disclosure required by Section 162.256, Occupations Code.
         Sec. 1223.057.  ENFORCEMENT. The department may take an
  enforcement action under Subtitle B, Title 2, against an issuer
  that violates this chapter.
         SECTION 2.  Not later than January 1, 2022, the commissioner
  of insurance shall adopt rules necessary to implement Chapter 1223,
  Insurance Code, as added by this Act.
         SECTION 3.  Chapter 1223, Insurance Code, as added by this
  Act, applies only to a health benefit plan or health expense
  arrangement delivered, issued for delivery, entered into, or
  renewed on or after January 1, 2022.
         SECTION 4.  This Act takes effect September 1, 2021.