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. 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, a group hospital service corporation
operating under Chapter 842, a health maintenance organization
operating under Chapter 843, and a stipulated premium company
operating under Chapter 844.
(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; or
(E) requires the health benefit plan to exceed
federal requirements.
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 essential health benefits as defined by 42 C.F.R.
Section 440.347.
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, either wholly or partly, does not provide
state-mandated health benefits 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 than those
normally included as state-mandated health benefits in health
benefit plans in Texas. If you choose this employer health benefit
plan, please consult with your insurance agent to discover which
state-mandated health benefits 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, either wholly
or partly, does not provide state-mandated health benefits 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 than those normally included as state-mandated
health benefits in health benefit plans in Texas. Please consult
with your insurance agent to discover which state-mandated health
benefits 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 an initial 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. An
employer choice of benefits plan provided under this chapter is
exempt from any other insurance law, including common law, that
does not expressly apply to the plan or this chapter.
SECTION 2. 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.
