89R5875 SCR-F     By: Dean H.B. No. 139       A BILL TO BE ENTITLED   AN ACT   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.