87R5122 RDS-F
 
  By: Oliverson H.B. No. 3923
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to multiple employer welfare arrangements.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter A, Chapter 846, Insurance Code, is
  amended by adding Section 846.0035 to read as follows:
         Sec. 846.0035.  APPLICABILITY OF CERTAIN LAWS TO ASSOCIATION
  PROVIDING HEALTH BENEFITS. (a) A multiple employer welfare
  arrangement that provides a comprehensive health benefit plan, as
  determined by the commissioner, is subject to the following laws as
  if the arrangement were an insurer, individuals entitled to
  coverage under the plan were insureds, and the health benefits were
  provided through an insurance policy:
               (1)  Chapter 421;
               (2)  Chapter 422;
               (3)  Subchapters C, F, and K, Chapter 1451; and
               (4)  Chapter 4201.
         (b)  A multiple employer welfare arrangement that provides a
  comprehensive health benefit plan, as determined by the
  commissioner, that is determined by the commissioner to be
  structured in the manner of a preferred provider benefit plan or an
  exclusive provider benefit plan as defined in Section 1301.001 is
  subject to the following laws as if the arrangement were an insurer,
  individuals entitled to coverage under the plan were insureds, and
  the health benefits were provided through an insurance policy:
               (1)  Chapter 1301; and
               (2)  Chapter 1467.
         SECTION 2.  Section 846.053, Insurance Code, is amended by
  amending Subsections (b) and (c) and adding Subsection (d-1) to
  read as follows:
         (b)  The employers in the multiple employer welfare
  arrangement must:
               (1)  be members of an association or group of five or
  more businesses that are in the same trade or industry, including
  closely related businesses that provide support, services, or
  supplies primarily to that trade or industry; or
               (2)  each have a principal place of business in the same
  region that does not exceed the boundaries of this state or the
  boundaries of a metropolitan statistical area designated by the
  United States Office of Management and Budget.
         (c)  If the employers in the multiple employer welfare
  arrangement are members of an association, the association must[:
               [(1)] be engaged in substantial activity for its
  members other than sponsorship of an employee welfare benefit
  plan[; and
               [(2)  have been in existence for at least two years
  before engaging in any activities relating to providing employee
  health benefits to its members].
         (d-1)  A working owner of a trade or business without
  employees may qualify as both an employer and as an employee of the
  trade or industry for the purposes of this section.  In this
  subsection, "working owner" means an individual who:
               (1)  has an ownership right of any nature in a trade or
  business, whether incorporated or unincorporated, including a
  partner and other self-employed individual;
               (2)  earns wages or self-employment income from the
  trade or business for providing personal services to the trade or
  business; and
               (3)  either:
                     (A)  works on average at least 20 hours per week or
  at least 80 hours per month providing personal services to the
  working owner's trade or business; or
                     (B)  has wages or self-employment income from the
  individual's trade or business that at least equals the
  individual's cost of coverage for participation by the individual
  and any covered beneficiaries in the group health plan sponsored by
  the group or association in which the individual is participating.
         SECTION 3.  Section 846.0035, Insurance Code, as added by
  this Act, applies only to a health benefit plan provided under an
  agreement entered into or renewed on or after January 1, 2022.
         SECTION 4.  Section 846.053, Insurance Code, as amended by
  this Act, applies only to an application for a certificate of
  authority as a multiple employer welfare arrangement submitted on
  or after January 1, 2022. An application submitted before January
  1, 2022, is governed by the law as it existed immediately before the
  effective date of this Act, and that law is continued in effect for
  that purpose.
         SECTION 5.  This Act takes effect September 1, 2021.