S.B. No. 805
AN ACT
relating to certain small and large employer health cooperatives
and reinsurance for small employer health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 1501, Insurance Code, as
effective April 1, 2005, and as amended by the Act of the 79th
Legislature, Regular Session, 2005, relating to nonsubstantive
additions to and corrections in enacted codes (the general code
update bill), is amended by adding Section 1501.0575 to read as
follows:
Sec. 1501.0575. VOLUNTARY PARTICIPATION BY ISSUER IN
COOPERATIVE. A health benefit plan issuer may elect not to
participate in a health group cooperative. The health benefit plan
issuer may elect to participate in one or more health group
cooperatives and may select the cooperatives in which the issuer
will participate.
SECTION 2. Section 1501.0581, Insurance Code, as added by
the Act of the 79th Legislature, Regular Session, 2005, relating to
nonsubstantive additions to and corrections in enacted codes (the
general code update bill), is amended by amending Subsections (a),
(b), and (c) and adding Subsections (o) and (p) to read as follows:
(a) The membership of a health group cooperative may consist
only of small employers or may consist only of large employers, but
may not[, at the option of the health group cooperative,] consist of
both small and large employers. To participate as a member of a
health group cooperative, an employer must be a small or large
employer as described by this chapter.
(b) Subject to the requirements imposed on small employer
health benefit plan issuers under Section 1501.101, a health group
cooperative:
(1) shall allow a small employer to join a [the] health
group cooperative consisting only of small employers and enroll in
health benefit plan coverage, subject to Subsection (o); and
(2) may allow a large employer to join a [the] health
group cooperative consisting only of large employers and enroll in
health benefit plan coverage.
(c) Subject to Subsection (o), a [A] health group
cooperative consisting only of small employers shall allow any
small employer to join the health group cooperative and enroll in
the cooperative's health benefit plan coverage during the initial
enrollment and annual open enrollment periods.
(o) A health group cooperative consisting only of small
employers is not required to allow a small employer to join the
health group cooperative under Subsection (c) if:
(1) the cooperative has elected to restrict membership
in the cooperative in accordance with this subsection and
Subsection (p); and
(2) after the small employer has joined the
cooperative, the total number of eligible employees employed on
business days during the preceding calendar year by all small
employers participating in the cooperative would exceed 50.
(p) A health group cooperative must make the election
described by Subsection (o) at the time the cooperative is
initially formed. Evidence of the election must be filed in writing
with the commissioner in the form and at the time prescribed by the
commissioner by rule.
SECTION 3. Section 1501.063, Insurance Code, as effective
April 1, 2005, and as amended by the Act of the 79th Legislature,
Regular Session, 2005, relating to nonsubstantive additions to and
corrections in enacted codes (the general code update bill), is
amended by amending Subsection (b) and adding Subsections (b-1),
(b-2), and (b-3) to read as follows:
(b) A health group cooperative [that is composed only of
small employers] is considered a single employer under this code.
(b-1) A health group cooperative that is composed only of
small employers and that has made the election described by Section
1501.0581(o)(1) in accordance with Subsection (p) of that section
[and] shall be treated in the same manner as a small employer for
the purposes of this chapter, including for the purposes of any
provision relating to premium rates and issuance and renewal of
coverage.
(b-2) A health group cooperative that is composed only of
small [and large] employers and that has not made the election
described by Section 1501.0581(o)(1) in accordance with Subsection
(p) of that section, or a health group cooperative that is composed
only of large employers, shall be treated in the same manner as a
large employer for the purposes of this chapter, including for the
purposes of any provision relating to premium rates and issuance
and renewal of coverage.
(b-3) [is considered a single employer under this code and,
in relation to the small employers that are members of the
cooperative, shall be treated in the same manner as a small
employer. A health group cooperative that is composed of small and
large employers may elect to extend the protections of this chapter
that are applicable to small employer groups to the large employer
groups that participate in the cooperative.] A health group
cooperative shall have sole authority to make benefit elections and
perform other administrative functions under this code for the
cooperative's participating employers.
SECTION 4. Subchapter G, Chapter 1501, Insurance Code, is
amended by adding Section 1501.3241 to read as follows:
Sec. 1501.3241. TEMPORARY LIMIT ON TOTAL ASSESSMENTS.
Notwithstanding Section 1501.324, the maximum assessment amount
payable for a calendar year may not exceed 10 percent of the total
premiums earned in the preceding calendar year from small employer
health benefit plans delivered or issued for delivery by reinsured
health benefit plan issuers in this state. This section expires
September 1, 2007.
SECTION 5. Section 1501.325, Insurance Code, is amended by
amending Subsections (d) and (e) and adding Subsections (d-1) and
(e-1) to read as follows:
(d) A reinsured health benefit plan issuer may not cede
additional eligible lives to the system [write small employer
health benefit plans on a guaranteed issue basis] during a calendar
year if the assessment amount payable for the preceding calendar
year is at least five percent of the total premiums earned in that
calendar year from small employer health benefit plans delivered or
issued for delivery by reinsured health benefit plan issuers in
this state.
(d-1) During the period that this subsection is effective,
Subsection (d) is not effective. A reinsured health benefit plan
issuer may not cede additional eligible lives to the system during a
calendar year if the assessment amount payable for the preceding
calendar year is at least 10 percent of the total premiums earned in
that calendar year from small employer health benefit plans
delivered or issued for delivery by reinsured health benefit plan
issuers in this state. This subsection expires September 1, 2007.
(e) A reinsured health benefit plan issuer may not cede
additional eligible lives to the system [write small employer
health benefit plans on a guaranteed issue basis] after the board
determines that the expected loss from the reinsurance system for a
year will exceed the total amount of assessments payable at a rate
of five percent of the total premiums earned for the preceding
calendar year. A reinsured health benefit plan issuer may not
resume ceding additional eligible lives to the system [writing
small employer health benefit plans on a guaranteed issue basis]
until the board determines that the expected loss will be less than
the maximum established by this subsection.
(e-1) During the period that this subsection is effective,
Subsection (e) is not effective. A reinsured health benefit plan
issuer may not cede additional eligible lives to the system after
the board determines that the expected loss from the reinsurance
system for a year will exceed the total amount of assessments
payable at a rate of 10 percent of the total premiums earned for the
preceding calendar year. A reinsured health benefit plan issuer
may not resume ceding additional eligible lives to the system until
the board determines that the expected loss will be less than the
maximum established by this subsection. This subsection expires
September 1, 2007.
SECTION 6. Notwithstanding Subsection (p), Section
1501.0581, Insurance Code, as added by this Act, a health group
cooperative in existence on the effective date of this Act may make
the election described by Subsection (o), Section 1501.0581,
Insurance Code, as added by this Act, not later than December 31,
2005.
SECTION 7. Not later than January 1, 2006, the commissioner
of insurance shall adopt rules under Section 1501.010, Insurance
Code, as necessary to implement the change in law made by this Act.
SECTION 8. This Act takes effect only if S.B. No. 979 or
H.B. No. 2018 or another Act of the 79th Legislature, Regular
Session, 2005, relating to nonsubstantive additions to and
corrections in enacted codes becomes law. If S.B. No. 979 or H.B.
No. 2018 or another Act of the 79th Legislature, Regular Session,
2005, relating to nonsubstantive additions to and corrections in
enacted codes does not become law, this Act has no effect.
SECTION 9. To the extent of any conflict, this Act prevails
over another Act of the 79th Legislature, Regular Session, 2005,
relating to nonsubstantive additions to and corrections in enacted
codes.
SECTION 10. This Act takes effect September 1, 2005.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 805 passed the Senate on
April 21, 2005, by the following vote: Yeas 31, Nays 0;
May 27, 2005, Senate refused to concur in House amendment and
requested appointment of Conference Committee; May 28, 2005, House
granted request of the Senate; May 29, 2005, Senate adopted
Conference Committee Report by the following vote: Yeas 31,
Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 805 passed the House, with
amendment, on May 25, 2005, by a non-record vote; May 28, 2005,
House granted request of the Senate for appointment of Conference
Committee; May 29, 2005, House adopted Conference Committee Report
by a non-record vote.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor