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AN ACT
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relating to the regulation of group family leave insurance issued |
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through an employer to pay for certain losses of income. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The purpose of this Act is to bring clarity to |
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the laws of this state that paid family leave insurance may be |
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provided by any insurer authorized to write life or health |
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insurance, including disability income insurance, in this state and |
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that family leave insurance is considered a type of disability |
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income insurance. |
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SECTION 2. Subtitle B, Title 8, Insurance Code, is amended |
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by adding Chapter 1255 to read as follows: |
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CHAPTER 1255. GROUP FAMILY LEAVE INSURANCE |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 1255.001. DEFINITIONS. In this chapter: |
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(1) "Continuing supervision by a health care provider" |
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includes a period of incapacity that is permanent or long-term due |
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to a condition for which treatment may not be effective and for |
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which the affected individual is not receiving active treatment by |
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a health care provider. |
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(2) "Dependent" means an individual who is under 18 |
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years of age, or 18 years of age or older and incapable of self-care |
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due to a mental or physical disability, and is, in relation to an |
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insured: |
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(A) a biological, adopted, or foster child; |
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(B) a legal ward; |
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(C) a child of the insured's spouse; |
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(D) a child with respect to whom the insured is a |
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party to a suit in which the insured seeks to adopt the child; or |
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(E) a child of a person to whom the insured stands |
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in loco parentis. |
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(3) "Family leave" means leave taken by an employee |
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from work for reasons described by Section 1255.102. |
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(4) "Family leave insurance" means an insurance policy |
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issued through an employer related to a benefit program provided to |
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an employee to pay for a portion of the employee's income loss due |
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to family leave taken by the employee. |
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(5) "Family member," in relation to an insured, |
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includes a dependent, spouse, or parent or any other person defined |
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as a family member in the family leave insurance policy. |
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(6) "Health care provider" means a person licensed, |
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certified, or otherwise authorized by the laws of this state to |
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provide health care services in the ordinary course of business or |
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practice of a profession. |
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(7) "Parent" means, in relation to an insured: |
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(A) a biological, adoptive, or foster parent; |
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(B) a stepparent; |
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(C) a legal guardian; or |
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(D) a person who stood in loco parentis to the |
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insured when the insured was a child. |
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(8) "Serious health condition" means an illness, |
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injury, impairment, or physical or mental condition, including |
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transplantation preparation and recovery from surgery related to |
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organ or tissue donation, that involves: |
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(A) inpatient care in a hospital, hospice, or |
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residential health care facility; |
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(B) continuing treatment; or |
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(C) continuing supervision by a health care |
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provider. |
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Sec. 1255.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a family leave insurance policy, amendment, or |
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rider to a group disability policy delivered or issued for delivery |
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in this state by a life, health, and accident insurance company. |
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(b) Notwithstanding Chapter 1701 and except as provided by |
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Section 1255.108, this chapter does not apply to a certificate of |
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family leave insurance delivered to a resident in this state if the |
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group policy was delivered or issued for delivery in another state. |
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(c) This chapter applies to an insurance company authorized |
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to write life, health, and accident insurance in this state, |
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including a stipulated premium company operating under Chapter 884. |
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(d) This chapter does not apply to: |
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(1) a society, company, or other insurer whose |
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activities are exempt by statute from department regulation and |
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that is entitled by statute to a certificate from the department |
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that shows the entity's exempt status; |
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(2) a credit accident and health insurance policy |
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issued under Chapter 1153; |
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(3) a workers' compensation insurance policy; |
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(4) a liability insurance policy, with or without |
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supplementary expense coverage; |
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(5) a reinsurance policy or contract; |
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(6) a blanket or group insurance policy, except as |
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otherwise provided by this chapter; or |
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(7) a life insurance endowment or annuity contract, or |
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a contract supplemental to a life insurance endowment or annuity |
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contract, if the contract or supplemental contract contains only |
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provisions relating to accident and health insurance that: |
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(A) provide additional benefits in case of |
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accidental death, accidental dismemberment, or accidental loss of |
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sight; or |
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(B) operate to: |
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(i) safeguard the contract or supplemental |
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contract against lapse; or |
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(ii) give a special surrender value, a |
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special benefit, or an annuity if the insured or annuitant becomes |
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totally and permanently disabled, as defined by the contract or |
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supplemental contract. |
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Sec. 1255.003. CONSIDERATION AS DISABILITY INCOME |
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INSURANCE. A family leave insurance policy is considered a type of |
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disability income insurance for all purposes under this code. |
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Sec. 1255.004. APPLICATION OF OTHER LAW; CONFLICTS. (a) |
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The provisions of Subchapter B, Chapter 1251, governing eligibility |
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for group accident and health insurance apply to govern the |
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eligibility of a group for purposes of this chapter to the extent |
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those provisions do not conflict with this chapter. This chapter |
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prevails over Subchapter B, Chapter 1251, if there is a conflict. |
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(b) Notwithstanding any other law, the law of the state in |
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which the group or master policy providing family leave insurance |
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is delivered or issued for delivery governs disputes between the |
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insurer, group policyholder, and certificate holder. |
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Sec. 1255.005. RULEMAKING AUTHORITY. The commissioner may |
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adopt reasonable rules as necessary to implement this chapter. |
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SUBCHAPTER B. MINIMUM POLICY STANDARDS |
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Sec. 1255.101. COMPLIANCE WITH MINIMUM STANDARDS FOR |
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BENEFITS. A group family leave insurance policy must meet the |
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minimum standards for benefits as provided by this subchapter. |
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Sec. 1255.102. FAMILY LEAVE BENEFITS. A group family leave |
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insurance policy may provide benefits for any leave taken by an |
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insured from work to: |
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(1) participate in providing care, including physical |
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or psychological care, for a family member of the insured made |
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necessary by a serious health condition of the family member; |
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(2) bond with the insured's child during the first 12 |
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months after the child's birth, or the first 12 months after the |
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placement of the child for adoption or foster care with the insured; |
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(3) address a qualifying exigency, as interpreted |
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under the Family and Medical Leave Act of 1993 (29 U.S.C. Section |
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2612(a)(1)(E)) and 29 C.F.R. Sections 825.126(b)(1)-(8), arising |
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from the fact that the spouse, dependent, or parent of the insured |
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is on active duty or has been notified of an impending call or order |
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to active duty in the armed forces of the United States, including |
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the National Guard and armed forces reserves; |
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(4) care for a family member described by Subdivision |
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(3) who is injured in the line of duty; or |
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(5) take other leave to provide care for a family |
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member or other family leave as specified in the policy. |
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Sec. 1255.103. EXPLANATION OF COVERED FAMILY LEAVE REASONS. |
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A group family leave insurance policy must provide the details |
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regarding and requirements for each covered family leave reason. |
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Sec. 1255.104. BENEFIT PERIOD. (a) A group family leave |
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insurance policy must establish the length of family leave benefits |
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that are available for each covered family leave reason. |
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(b) The length of family leave benefits available for a |
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covered family leave reason may not be less than two weeks during a |
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period of 52 consecutive calendar weeks. |
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(c) A group family leave insurance policy may calculate the |
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52 consecutive calendar weeks by any of the following methods: |
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(1) a calendar year; |
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(2) a fixed period starting on a particular date, |
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including an effective or anniversary date; |
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(3) the period measured forward from the insured's |
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first day of family leave; |
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(4) a rolling period measured from the insured's first |
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day of family leave; or |
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(5) any other method that is specified in the policy. |
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Sec. 1255.105. WAITING PERIOD. (a) A group family leave |
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insurance policy must specify whether there is an unpaid waiting |
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period. |
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(b) If a group family leave insurance policy contains an |
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unpaid waiting period, the terms of the unpaid waiting period may |
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include: |
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(1) whether the waiting period runs over a consecutive |
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calendar day period; |
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(2) whether the waiting period is counted toward the |
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annual allotment of family leave benefits or is in addition to the |
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annual allotment of family leave benefits; |
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(3) whether the waiting period must be met only once |
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per benefit year or must be met for each separate claim for |
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benefits; and |
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(4) whether the insured may work or receive paid time |
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off or other compensation by the employer during the waiting |
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period. |
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Sec. 1255.106. AMOUNT OF FAMILY LEAVE BENEFITS; OTHER |
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INCOME. (a) A group family leave insurance policy must specify: |
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(1) the amount of benefits that will be paid for |
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covered family leave reasons; |
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(2) the definition of wages or other income on which |
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the amount of family leave benefits is based; and |
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(3) the method for calculating those wages or other |
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income. |
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(b) If the family leave benefits are subject to offsets for |
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wages or other income received by the insured or for which the |
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insured may be eligible, the group family leave insurance policy |
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must specify: |
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(1) which wages or other income may be offset; and |
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(2) the circumstances under which the wages or other |
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income may be offset. |
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Sec. 1255.107. PERMISSIBLE LIMITATIONS, EXCLUSIONS, OR |
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REDUCTIONS. (a) A group family leave insurance policy that limits, |
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excludes, or reduces eligibility for family leave benefits under |
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this chapter must state the limit, exclusion, or reduction in the |
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policy. |
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(b) Permissible limitations, exclusions, or reductions in |
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the policy include a limitation, exclusion, or reduction for: |
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(1) a period of family leave for which the required |
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notice and medical certification have not been provided as |
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prescribed by the policy; |
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(2) family leave related to a serious health condition |
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or other harm to a family member brought about by the wilful |
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intention of the insured; |
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(3) a period of family leave during which the insured |
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performed work for compensation or profit; |
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(4) a period of family leave for which the insured is |
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eligible to receive money from the insured's employer or from a fund |
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to which the employer has contributed; |
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(5) a period of family leave in which the insured is |
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eligible to receive benefits under another statutory program or |
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employer-sponsored program, including unemployment insurance |
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benefits, workers' compensation benefits, statutory disability |
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benefits, statutory paid leave benefits, or paid time off from the |
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employer's paid leave policy; |
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(6) a period of family leave beginning before the |
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insured becomes eligible for family leave benefits under the |
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policy; or |
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(7) periods of family leave during which more than one |
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person covered under the policy seeks family leave for the same |
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family member. |
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Sec. 1255.108. CERTIFICATE OF INSURANCE. (a) An insurer |
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providing family leave insurance shall issue a certificate of |
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insurance to each employee or member of the insured group. |
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(b) The certificate of insurance must include: |
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(1) a summary of the essential features of the paid |
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family leave insurance coverage and benefits available to the |
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insured; |
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(2) the limitations, exclusions, or reductions; |
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(3) the annual and lifetime policy limits; and |
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(4) the person to whom the benefits are payable. |
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(c) An insurer may file a certificate issued to an insured |
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in this state for a group policy providing family leave insurance |
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that was delivered or issued for delivery in another state with the |
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department for informational purposes. |
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(d) An insurer is not required to file or receive approval |
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under Chapter 1701 for a certificate for a foreign group. |
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SECTION 3. This Act applies only to a family leave insurance |
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policy, amendment, or rider delivered, issued for delivery, or |
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renewed on or after January 1, 2024. |
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SECTION 4. This Act takes effect September 1, 2023. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 1996 was passed by the House on April |
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25, 2023, by the following vote: Yeas 146, Nays 2, 1 present, not |
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voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 1996 was passed by the Senate on May |
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22, 2023, by the following vote: Yeas 31, Nays 0. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: _____________________ |
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Date |
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_____________________ |
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Governor |