89R21810 SCR-F     By: Dean, Harless, Hull, Gerdes, Tepper, H.B. No. 139       et al.     Substitute the following for H.B. No. 139:     By:  Dean C.S.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.  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.