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A BILL TO BE ENTITLED
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AN ACT
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relating to disclosure requirements for health benefit plans and |
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health expense arrangements marketed to individuals. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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by adding Chapter 1223 to read as follows: |
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CHAPTER 1223. MANDATORY DISCLOSURES FOR CERTAIN HEALTH BENEFIT |
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PLANS AND HEALTH EXPENSE ARRANGEMENTS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 1223.001. DEFINITION. In this chapter, "issuer" means |
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a person who markets, sells, issues, or operates a health benefit |
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plan or health expense arrangement governed by this chapter. |
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Sec. 1223.002. APPLICABILITY. Except as provided by |
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Section 1223.003 but notwithstanding any other law, this chapter |
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applies to a health benefit plan or health expense arrangement |
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marketed to an individual to provide health benefit coverage or pay |
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for health care expenses, including: |
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(1) an individual accident and health insurance policy |
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governed by Chapter 1201; |
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(2) a group accident and health insurance policy |
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governed by Chapter 1251 that is marketed to an individual; |
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(3) individual health maintenance organization |
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coverage; |
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(4) a health care sharing ministry operated under |
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Chapter 1681; |
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(5) a discount health care program governed by Chapter |
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7001; |
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(6) a direct primary care arrangement governed by |
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Subchapter F, Chapter 162, Occupations Code; or |
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(7) any other plan or arrangement the commissioner |
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determines is or could be marketed to an individual as an |
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alternative or supplement to an employer-provided health benefit |
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plan or health benefit plan coverage regulated under the Patient |
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Protection and Affordable Care Act (Pub. L. No. 111-148). |
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Sec. 1223.003. EXCEPTION. This chapter does not apply to a |
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health benefit plan or health expense arrangement if: |
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(1) the issuer is required to submit a summary of |
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benefits and coverage for the plan or arrangement to the United |
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States secretary of health and human services under 42 U.S.C. |
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Section 300gg-15; or |
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(2) the issuer is required to provide a disclosure |
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form for the plan or arrangement under Section 1509.002. |
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Sec. 1223.004. RULES. The commissioner may adopt rules |
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necessary to implement this chapter. |
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SUBCHAPTER B. DISCLOSURE REQUIRED |
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Sec. 1223.051. DISCLOSURE FORM TEMPLATE. (a) The |
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commissioner by rule shall prescribe a disclosure form template for |
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each type of health benefit plan or health expense arrangement to |
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which this chapter applies. |
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(b) The commissioner shall ensure that the disclosure form |
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template is presented in plain language and in a standardized |
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format designed to facilitate consumer understanding. |
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(c) The commissioner may prescribe as many disclosure form |
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templates as necessary to account for each type of health benefit |
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plan or health expense arrangement. |
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(d) Except as provided by Subsection (e), the disclosure |
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form template must include the following information that is |
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tailored to the type of health benefit plan or health expense |
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arrangement described by the template: |
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(1) a statement: |
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(A) of whether the plan or arrangement is |
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insurance; and |
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(B) of what, if any, guarantees are made of |
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payment for health care services; |
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(2) the duration of coverage; |
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(3) a statement: |
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(A) of whether: |
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(i) the plan or arrangement may be renewed |
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at the option of the enrollee or participant with no new |
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underwriting;Statutes affected:
Introduced: ()
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