Relating to employer health benefit plans that do not include state-mandated health benefits.
relating to employer health benefit plans that do not include
state-mandated health benefits.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1251.202, Insurance Code, is amended to
read as follows:
Sec. 1251.202. NOTICE REGARDING CERTAIN EMPLOYER HEALTH
BENEFIT PLANS. (a) In this section:
(1) “Employer choice of benefits plan” means a plan
offered under Chapter 1506.
(2) [,] “Standard [standard] health benefit plan”
means a plan offered under Chapter 1507.
(b) If an employer offers to employees an employer choice of
benefits plan or a standard health benefit plan, the employer
shall:
(1) provide a copy of the disclosure statement
provided to the employer by the plan issuer under Section 1506.102,
1507.006, or 1507.056, as applicable, to:
(A) each employee:
(i) before the employee initially enrolls
in the plan, unless the employee received notice under Paragraph
(B) on or after the 90th day before the date the employee initially
enrolls; and
(ii) not later than the 30th day before the
date the employee renews enrollment in the plan; and
(B) each prospective employee before the
prospective employee is hired by the employer; and
(2) obtain a copy of the notice signed by the employee
or prospective employee at the time the notice is provided.
SECTION 2. Section 1275.002, Insurance Code, is amended to
read as follows:
Sec. 1275.002. APPLICABILITY OF CHAPTER. This chapter
applies only to:
(1) a health benefit plan offered by a nonprofit
agricultural organization under Chapter 1682; [and]
(2) a health benefit plan:
(A) that is a self-insured or self-funded plan
established by an employer for the benefit of the employer’s
employees in accordance with the Employee Retirement Income
Security Act of 1974 (29 U.S.C. Section 1001 et seq.); and
(B) for which the plan sponsor has made an
election, submitted to the commissioner in the form and manner
prescribed by the commissioner, to apply this chapter to the plan
for the relevant plan year; and
(3) an employer choice of benefits plan offered under
Chapter 1506.
SECTION 3. Section 1501.002(15), Insurance Code, is amended
to read as follows:
(15) “Small employer health benefit plan” means a
health benefit plan developed by the commissioner under Subchapter
F [or any other health benefit plan offered to a small employer in
accordance with Section 1501.252(c) or 1501.255].
SECTION 4. Section 1501.213(b), Insurance Code, is amended
to read as follows:
(b) A health maintenance organization that participates in
a purchasing cooperative that provides employees of small employers
a choice of health benefit plans may use rating methods in
accordance with this subchapter that are used by other small
employer health benefit plan issuers participating in the same
cooperative, including rating by age and gender, if the health
maintenance organization has established[:
[(1)] a separate class of business, as provided by
Section 1501.202[; and
[(2) a separate line of business, as provided under
Section 1501.255(b)].
SECTION 5. Subtitle G, Title 8, Insurance Code, is amended
by adding Chapter 1506 to read as follows:
CHAPTER 1506. EMPLOYER CHOICE OF BENEFITS PLANS
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1506.001. DEFINITIONS. In this chapter:
(1) “Employer choice of benefits plan” means a group
health benefit plan offered to an employer that, wholly or partly,
does not offer or provide state-mandated health benefits, but that
provides creditable coverage as defined by Section 1205.004(a) or
1501.102(a).
(2) “Health benefit plan issuer” means any entity
authorized under this code or another insurance law of this state to
provide health insurance or health benefits in this state. The term
includes an insurance company and a health maintenance organization
operating under Chapter 843.
(3) “State-mandated health benefits” means coverage
or another feature required under this code or other laws of this
state to be provided in a group health benefit plan that:
(A) includes coverage for specific health care
services or benefits;
(B) places limitations or restrictions on
deductibles, coinsurance, copayments, or any annual or lifetime
maximum benefit amounts, including limitations provided by
commissioner rule;
(C) includes a specific category of licensed
health care practitioner from whom an enrollee is entitled to
receive care;
(D) requires standard provisions or rights that
are unrelated to a specific health illness, injury, or condition of
an enrollee;
(E) requires the health benefit plan to provide
coverage for health care services or benefits in excess of federal
requirements; or
(F) is a requirement for which an exemption is
provided under Section 1506.105.
Sec. 1506.002. RULES. The commissioner shall adopt rules
necessary to implement this chapter.
SUBCHAPTER B. EMPLOYER CHOICE OF BENEFITS PLANS
Sec. 1506.101. PLANS AUTHORIZED. (a) A health benefit plan
issuer may offer one or more employer choice of benefits plans.
(b) An employer choice of benefits plan must include
coverage for an essential health benefits package as determined by
the commissioner based on 42 U.S.C. Section 18022, including:
(1) ambulatory patient services;
(2) emergency services;
(3) hospitalization;
(4) maternity and newborn care;
(5) mental health and substance use disorder services,
including behavioral health treatment;
(6) prescription drugs;
(7) rehabilitative and habilitative services and
devices;
(8) laboratory services;
(9) preventative and wellness services and chronic
disease management; and
(10) pediatric services, including oral and vision
care.
(c) An employer choice of benefits plan may not include a
preexisting condition exclusion.
Sec. 1506.102. NOTICE TO ENROLLEES. (a) Each written
application to enroll in an employer choice of benefits plan must
contain the following language at the beginning of the document in
bold type:
“You have the option to enroll in this Employer Choice
of Benefits Plan that does not provide all coverage or features
normally required in health benefit plans in Texas. This employer
health benefit plan may provide a more affordable health benefit
plan for you, although, at the same time, it may provide you with
fewer health benefits or other features than those normally
included in health benefit plans in Texas. If you choose this
employer health benefit plan, please consult with your plan issuer
to discover which state-mandated health benefits or other features
are excluded from this health benefit plan.”
(b) Each employer choice of benefits plan must contain the
following language at the beginning of the document in bold type:
“This Employer Choice of Benefits Plan does not provide
all coverage or features normally required in health benefit plans
in Texas. This employer health benefit plan may provide a more
affordable health benefit plan for you, although, at the same time,
it may provide you with fewer health benefits or other features than
those normally included in health benefit plans in Texas. Please
consult with your employer representative to discover which
state-mandated health benefits or other features are excluded from
this health benefit plan.”
Sec. 1506.103. DISCLOSURE STATEMENT. (a) Before a health
benefit plan issuer may contract to provide an employer choice of
benefits plan to an employer, the issuer must provide the employer
with a written disclosure statement that:
(1) acknowledges that the employer health benefit plan
being contracted for does not provide some or all state-mandated
health benefits; and
(2) lists those state-mandated health benefits not
included in the plan.
(b) An employer entering into a contract for an employer
choice of benefits plan must sign the disclosure statement provided
by the health benefit plan issuer under Subsection (a) and return
the statement to the issuer.
(c) A health benefit plan issuer shall:
(1) retain the signed disclosure statement in the
health benefit plan issuer’s records; and
(2) on request from the commissioner, provide the
signed disclosure statement to the department.
Sec. 1506.104. ADDITIONAL HEALTH BENEFIT PLANS. A health
benefit plan issuer that offers one or more employer choice of
benefits plans must also offer employers at least one group health
benefit plan that provides state-mandated health benefits and is
otherwise authorized by this code.
Sec. 1506.105. COVERAGE EXEMPT FROM INSURANCE LAW. (a)
Except as provided by Subsection (b), an employer choice of
benefits plan provided under this chapter is exempt from any other
insurance law that does not expressly apply to the plan or this
chapter.
(b) An employer choice of benefits plan is not exempt from
the requirements imposed by the following:
(1) Titles 2, 3, 4, 5, 6, 9, and 13, as applicable,
except that an employer choice of benefits plan offered by a health
maintenance organization is exempt from requirements imposed by
Chapter 843 to the extent that those requirements conflict with
this chapter;
(2) Subchapters B, C, and F, Chapter 1271; and
(3) Sections 843.209, 1301.1581, 1301.162, and
1369.153.
SECTION 6. The following provisions of the Insurance Code
are repealed:
(1) Section 1501.213(a);
(2) Section 1501.252;
(3) Section 1501.254;
(4) Section 1501.255; and
(5) Section 1501.259.
SECTION 7. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2025.
