By: Frank H.B. No. 3752
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the provision of health benefits coverage through the
  creation of the Texas Mutual Health Coverage Plan.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 2054.001, Insurance Code, is amended to
  read as follows:
         Sec. 2054.001.  DEFINITIONS. In this chapter:
               (1)  "Board" means the board of directors of the
  company.
               (2)  Repealed by Acts 2007, 80th Leg., R.S., Ch. 730,
  Sec. 3B.056, eff. September 1, 2007.
               (3)  "Company" means the Texas Mutual Insurance
  Company.
               (4)  "Workers' compensation insurance" means insurance
  for a risk under:
                     (A)  Subtitle A, Title 5, Labor Code;
                     (B)  Chapter 504, Labor Code;
                     (C)  the Longshore and Harbor Workers'
  Compensation Act (33 U.S.C. Section 901 et seq.);
                     (D)  the Federal Mine Safety and Health Act of
  1977 (30 U.S.C. Section 801 et seq.);
                     (E)  the Defense Base Act (42 U.S.C. Sections
  1651-1654);
                     (F)  the federal Employers' Liability Act (45
  U.S.C. Section 51 et seq.);
                     (G)  the Nonappropriated Fund Instrumentalities
  Act (5 U.S.C. Sections 8171-8173);
                     (H)  the Outer Continental Shelf Lands Act (43
  U.S.C. Section 1331 et seq.); or
                     (I)  the Merchant Marine Act of 1920 (46 App.
  U.S.C. Section 861 et seq.).
               (5)  "Texas Mutual Health Coverage Plan" means a health
  benefit plan offered to individual residents or small employers in
  the state outside of the workers' compensation marketplace.
               (6)  "Small employer" means a person who employed an
  average of at least two employees but not more than 50 employees on
  business days during the preceding calendar year and who employs at
  least two employees on the first day of the plan year. For purposes
  of this definition, a partnership is the employer of a partner.  
  This term applies only to the company's health benefits coverage
  business.
         SECTION 2.  Section 2054.151, Insurance Code, is amended to
  read as follows:
         Sec. 2054.151.  PURPOSE OF COMPANY. The company shall:
               (1)  serve as a competitive force in the workers'
  compensation and health benefit marketplaces;
               (2)  guarantee the availability of workers'
  compensation insurance in this state; and
               (3)  serve as an insurer of last resort as provided by
  Subchapter H.; and
               (4)  offer a competitive health coverage option to
  residents and small employers of this state.
         SECTION 3.  Section 2054.152, Insurance Code, is amended to
  read as follows:
         Sec. 2054.152.  PAYMENT OF TAXES, FEES, AND OTHER CHARGES.  
  The company shall pay the following in the same manner as a domestic
  mutual insurance company authorized to engage in the business of
  insurance and to write workers' compensation insurance or health
  benefit coverage in this state:
               (1)  taxes, including maintenance and premium taxes;
               (2)  fees; and
               (3)  payments due in lieu of taxes.
         SECTION 4.  Section 2054.155, Insurance Code, is amended to
  read as follows:
         Sec. 2054.155.  REQUIRED RESERVES.  The company shall
  establish and maintain reserves for losses on an actuarily sound
  basis in accordance with Chapter 424 as applicable and Chapter 426.
         SECTION 5.  Subchapter G, Chapter Section 2054, Insurance
  Code, is amended to read as follows:
  SUBCHAPTER G. ISSUANCE OF WORKERS' COMPENSATION COVERAGE
         Sec. 2054.301.  APPLICATION FOR COVERAGE. An application to
  the company for workers' compensation insurance coverage must be:
               (1)  made on the form prescribed by the company; and
               (2)  submitted directly by the applicant or by a
  general property and casualty agent on behalf of the applicant.
         Sec. 2054.302.  POLICY FORMS.  The company shall use the
  uniform policy and standard policy forms prescribed by the
  department under Section 2052.002.
         Sec. 2054.303.  DENIAL OF COVERAGE BASED ON CREDIT RISK. The
  company may refuse to write workers' compensation insurance
  coverage for an applicant that the company identifies as a credit
  risk unless the applicant, before a policy is issued:
               (1)  pays the total estimated premium and related
  charges; or
               (2)  provides security for payment of the total
  estimated premium and related charges.
         Sec. 2054.304.  CANCELLATION AND NONRENEWAL. The company
  may cancel or refuse to renew coverage on a workers' compensation
  policyholder as provided by Section 406.008, Labor Code.
         SECTION 6.  The title of Subchapter H, Chapter Section 2054,
  Insurance Code, is amended to read as follows:
  SUBCHAPTER H. COMPANY AS WORKERS' COMPENSATION INSURER OF LAST
  RESORT
         SECTION 7.  Chapter 2054, Insurance Code, is amended by
  adding Subchapter M to read as follows:
  SUBCHAPTER M. TEXAS MUTUAL HEALTH COVERAGE PLAN
         Sec. 2054.554  AUTHORITY TO DEVELOP AND OPERATE A HEALTH
  BENEFITS COVERAGE PLAN.  (a)  The company is authorized, based upon
  available funding, to develop, market, and operate a health
  benefits coverage plan to be offered to individuals who are
  residents of the state, or small employers.
         (b)  The board shall adopt any necessary bylaws or rules,
  with approval of the Texas Department of Insurance Commissioner, to
  establish standards governing the individuals and small employers
  eligible to purchase a Texas Mutual Health Coverage plan, benefit
  packages and plan offerings, which may include high-deductible
  catastrophic care options and the use of health savings accounts
  and flexible spending accounts, and multitiered premiums.
         Sec. 2054.555.  EXEMPTION. Notwithstanding any other
  provision of this code, this health benefit plan is not considered
  to be an insurance product and, as such, is not subject to
  applicable state and federal regulations governing traditional
  health insurance coverage.
         Sec. 2054.556.  ANNUAL STATEMENT; FILING FEE FOR HEALTH
  BENEFITS COVERAGE BUSINESS.  (a)  Not later than March 1 of each
  year, the company shall:
               (1)  prepare a statement showing the condition of the
  company as it relates to its health benefits coverage division on
  December 31 of the preceding year; and
               (2)  deliver the statement to the department
  accompanied by a filing fee in the amount determined under the
  commissioner.
         (b)  The statement must be under oath of two of the company's
  officers and show in detail the following information only as it
  relates to the company's health benefit coverage business:
               (1)  the character of the company's assets and
  liabilities on December 31 of the preceding year;
               (2)  the amount and character of business transacted
  and money received during the preceding year;
               (3)  how money was spent during the preceding year;
               (4)  the number and amount of the company's policies in
  force in this state on that date; and
               (5)  the total amount of the company's coverage
  policies in force on that date.
         SECTION 8.  This Act takes effect immediately if it receives
  a vote of two-thirds of all the members elected to each house, as
  provided by Section 39, Article III, Texas Constitution.  If this
  Act does not receive the vote necessary for immediate effect, this
  Act takes effect September 1, 2021.