Bill Text: TX HB4391 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to certain group and individual health benefit plans and the provision of health care benefits under health care plans through provider networks.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Introduced - Dead) 2019-03-25 - Referred to Insurance [HB4391 Detail]
Download: Texas-2019-HB4391-Introduced.html
| 86R13731 PMO-D | ||
| By: Sheffield | H.B. No. 4391 | |
|
|
||
|
|
||
| relating to certain group and individual health benefit plans and | ||
| the provision of health care benefits under health care plans | ||
| through provider networks. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle C, Title 6, Insurance Code, is amended | ||
| by adding Chapter 849 to read as follows: | ||
| CHAPTER 849. PROHIBITION OF PROVIDER NETWORKS | ||
| Sec. 849.0001. PURPOSE; CERTAIN PRACTICES PROHIBITED. The | ||
| purpose of this chapter is to prohibit the provision of health care | ||
| benefits by entities such as insurers and health maintenance | ||
| organizations through provider networks, preferred providers, or | ||
| similar arrangements. | ||
| Sec. 849.0002. DEFINITION. In this chapter, "health | ||
| benefit plan issuer" means: | ||
| (1) a health maintenance organization operating under | ||
| Chapter 843 or other person who arranges for or provides to | ||
| enrollees on a prepaid basis a health care plan, a limited health | ||
| care service plan, or a single health care service plan; and | ||
| (2) a life, health, and accident insurance company, | ||
| health and accident insurance company, health insurance company, or | ||
| other company operating under Chapter 841, 842, 884, 885, 982, | ||
| 1301, or 1501, that is authorized to issue, deliver, or issue for | ||
| delivery in this state health insurance policies. | ||
| Sec. 849.0003. PROHIBITION OF NETWORKS. (a) A health | ||
| benefit plan issuer may not: | ||
| (1) arrange for or provide to covered persons health | ||
| care services using a delivery network that directly or indirectly | ||
| contracts or subcontracts with physicians and other health care | ||
| providers; | ||
| (2) provide, through a policy or plan, for the payment | ||
| of a level of coverage that is different from the basic level of | ||
| coverage provided by the policy or plan if the covered person uses a | ||
| physician or health care provider, or an organization of physicians | ||
| or health care providers, who contracts to provide medical or | ||
| health care services to persons covered by the policy or plan; or | ||
| (3) otherwise provide health care benefits or arrange | ||
| for health care benefits to be provided to a covered person by | ||
| contracting directly or indirectly with a physician or health care | ||
| provider, or an organization of physicians or health care | ||
| providers, to provide medical or health care services to a covered | ||
| person on a capitation basis or otherwise. | ||
| (b) This section applies without regard to whether the | ||
| physician or health care provider who is a party to a contract | ||
| described by Subsection (a) is designated as a network provider or a | ||
| preferred provider or uses another designation. | ||
| (c) Notwithstanding any other law, a health benefit plan | ||
| issuer may provide health care benefits only by indemnifying the | ||
| covered person for medical or health care expenses. | ||
| Sec. 849.0004. EXCEPTION. Notwithstanding Section | ||
| 849.0003, health care benefits under the following programs may be | ||
| provided through health maintenance organizations, provider | ||
| networks, preferred providers, or similar arrangements: | ||
| (1) the child health plan program operated under | ||
| Chapter 62, Health and Safety Code; | ||
| (2) the state Medicaid program operated under Chapter | ||
| 32, Human Resources Code; | ||
| (3) the Medicaid managed care program operated under | ||
| Chapter 533, Government Code; | ||
| (4) the group benefits program under Chapter 1551; | ||
| (5) the group program under Chapter 1575; | ||
| (6) the uniform group coverage program under Chapter | ||
| 1579; and | ||
| (7) the uniform program under Chapter 1601. | ||
| SECTION 2. Subtitle B, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1255 to read as follows: | ||
| CHAPTER 1255. RESTRICTION OF AVAILABILITY OF GROUP HEALTH COVERAGE | ||
| IN CERTAIN CIRCUMSTANCES | ||
| Sec. 1255.0001. APPLICABILITY OF CHAPTER. (a) This | ||
| chapter applies only to a health benefit plan that provides | ||
| benefits for medical or surgical expenses incurred as a result of a | ||
| health condition, accident, or sickness, including a group, | ||
| blanket, or franchise insurance policy or insurance agreement, a | ||
| group hospital service contract, or a group evidence of coverage or | ||
| similar coverage document that is issued by: | ||
| (1) an insurance company; | ||
| (2) a group hospital service corporation operating | ||
| under Chapter 842; | ||
| (3) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium company operating under | ||
| Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this chapter applies to a | ||
| small employer health benefit plan subject to Chapter 1501, | ||
| including coverage provided through a health group cooperative | ||
| under Subchapter B of that chapter. | ||
| Sec. 1255.0002. RESTRICTION ON AVAILABILITY OF GROUP HEALTH | ||
| COVERAGE. (a) Notwithstanding Chapter 1251 or any other law, a | ||
| group health benefit policy that provides health benefits to an | ||
| employer group may not require that each employee eligible to | ||
| receive group health benefit coverage as a member of the employer | ||
| group be covered by the policy. | ||
| (b) An employee who is eligible to receive group health | ||
| benefit coverage as a member of an employer group may elect to | ||
| instead obtain health benefit coverage in the individual market or | ||
| from another source. | ||
| SECTION 3. The commissioner of insurance shall adopt rules | ||
| not later than January 1, 2020, to implement Chapters 849 and 1255, | ||
| Insurance Code, as added by this Act. | ||
| SECTION 4. The changes in law made by this Act apply only to | ||
| a health benefit plan that is delivered, issued for delivery, or | ||
| renewed on or after January 1, 2021. A health benefit plan | ||
| delivered, issued for delivery, or renewed before January 1, 2021, | ||
| is governed by the law as it existed immediately before the | ||
| effective date of this Act, and that law is continued in effect for | ||
| that purpose. | ||
| SECTION 5. This Act takes effect September 1, 2019. | ||
