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A BILL TO BE ENTITLED
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AN ACT
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relating to a biennial health coverage reference guide developed by |
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the Texas Department of Insurance. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle B, Title 5, Insurance Code, is amended |
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by adding Chapter 524A to read as follows: |
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CHAPTER 524A. PUBLIC EDUCATION ON HEALTH COVERAGE |
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Sec. 524A.001. BIENNIAL HEALTH COVERAGE REFERENCE GUIDE. |
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(a) The department shall consult with the Health and Human Services |
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Commission to develop a biennial reference guide designed to |
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educate the public about health coverage in this state. |
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(b) The reference guide must include the following |
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information: |
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(1) the biennial period covered by the current |
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edition; |
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(2) definitions of the term "health insurance" and |
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terms used to describe other forms of health coverage; |
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(3) sources from which consumers may obtain health |
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coverage, including through employers, and an explanation of how |
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coverage may be obtained from each of those sources; |
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(4) a guide to consumer rights and resources related |
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to health coverage; |
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(5) a health coverage shopping guide that includes: |
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(A) an explanation of discount cards and other |
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noninsurance health coverage products and a comparison of those |
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products to health insurance; |
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(B) an explanation and comparison of common types |
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of short-term or disease-specific health coverage; |
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(C) an explanation and comparison of preferred |
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provider benefit plans, exclusive provider benefit plans, health |
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maintenance organizations, and point-of-service plans; |
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(D) an explanation of provider networks and the |
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differences between in-network providers and out-of-network |
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providers; |
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(E) an explanation of the Affordable Care Act |
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marketplace plan categories of bronze, silver, gold, and platinum; |
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(F) an explanation of the out-of-pocket costs of |
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health coverage, including premiums, deductibles, copayments, and |
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coinsurance; and |
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(G) information on how to recognize health |
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coverage scams; |
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(6) an explanation of the effect of the Consolidated |
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Omnibus Budget Reconciliation Act of 1985 (Pub. L. No. 99-272) on |
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consumers' health coverage; |
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(7) a basic overview of federal, state, and local |
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programs that may assist consumers to obtain health care services; |
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(8) methods for a consumer to resolve disputes with a |
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health coverage issuer or administrator; |
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(9) methods to seek assistance from the department for |
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a complaint regarding a health coverage plan or product; and |
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(10) the areas of health coverage regulated by the |
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department and those regulated by federal law, including the |
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Employee Retirement Income Security Act of 1974 (29 U.S.C. Section |
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1001 et seq.). |
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(c) The department shall publish the reference guide |
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developed under this section on the department's Internet website |
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and in a printed form available to the public on request. |
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SECTION 2. The Texas Department of Insurance shall publish |
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the first biennial reference guide under Section 524A.001, |
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Insurance Code, as added by this Act, not later than January 1, |
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2026. |
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SECTION 3. This Act takes effect September 1, 2025. |
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