BILL ANALYSIS

S.B. 1307

By: Cook

Insurance

Committee Report (Unamended)

BACKGROUND AND PURPOSE

The bill sponsor has informed the committee that the Texas Department of Insurance (TDI) has detailed online resources for the public to reference when making health insurance decisions, but the resources are not consolidated, making it difficult for the public to access and comprehend. The Health and Human Services Commission (HHSC) publishes and maintains an aggregated reference guide for Medicaid and CHIP, providing straightforward and easily digestible information about these programs. The bill sponsor has also informed the committee that this guide has proven to be a valuable resource in simplifying the Medicaid and CHIP process and that creating a cumulative guide of resources from TDI would similarly help streamline health plan selection and provide the public with accurate information to make the best health care choice possible. S.B. 1307 requires TDI to consult with HHSC to develop a biennial reference guide designed to educate the public about health care coverage in Texas.

CRIMINAL JUSTICE IMPACT

It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.

RULEMAKING AUTHORITY

It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.

ANALYSIS

S.B. 1307 amends the Insurance Code to require the Texas Department of Insurance (TDI) to consult with the Health and Human Services Commission to develop a biennial reference guide designed to educate the public about health coverage in Texas. The bill requires the reference guide to include the following information:

· the biennial period covered by the current edition;

· definitions of the term "health insurance" and terms used to describe other forms of health coverage;

· sources from which consumers may obtain health coverage, including through employers, and an explanation of how coverage may be obtained from each of those sources;

· a guide to consumer rights and resources related to health coverage;

· a health coverage shopping guide that includes:

o an explanation of discount cards and other noninsurance health coverage products and a comparison of those products to health insurance;

o an explanation and comparison of common types of short-term or disease-specific health coverage;

o an explanation and comparison of preferred provider benefit plans, exclusive provider benefit plans, health maintenance organizations, and point-of-service plans;

o an explanation of provider networks and the differences between in-network providers and out-of-network providers;

o an explanation of the Affordable Care Act marketplace plan categories of bronze, silver, gold, and platinum;

o an explanation of the out-of-pocket costs of health coverage, including premiums, deductibles, copayments, and coinsurance; and

o information on how to recognize health coverage scams;

· an explanation of the effect of the federal Consolidated Omnibus Budget Reconciliation Act of 1985 on consumers' health coverage;

· a basic overview of federal, state, and local programs that may assist consumers to obtain health care services;

· methods for a consumer to resolve disputes with a health coverage issuer or administrator;

· methods to seek assistance from TDI for a complaint regarding a health coverage plan or product; and

· the areas of health coverage regulated by TDI and those regulated by federal law, including the federal Employee Retirement Income Security Act of 1974.

The bill requires TDI to publish the reference guide on TDI's website and in a printed form available to the public on request. TDI must publish the first reference guide not later than January 1, 2026.

EFFECTIVE DATE

September 1, 2025.