By: Jetton H.B. No. 2082
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to insurance regulation of a prepaid health care plan for
  certain individuals with low income.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle K, Title 8, Insurance Code, is amended
  by adding Chapter 1683 to read as follows:
  CHAPTER 1683.  PREPAID HEALTH CARE PLAN FOR CERTAIN INDIVIDUALS
  WITH LOW INCOME
         Sec. 1683.001.  INSURANCE REGULATION OF PREPAID HEALTH CARE
  PLAN FOR CERTAIN INDIVIDUALS WITH LOW INCOME. A plan for providing
  health care to individuals with low income on a prepaid basis is not
  considered to be engaging in the business of insurance if:
               (1)  eligibility in the plan is limited to:
                     (A)  individuals not covered under any other group
  insurance or health benefit plan arrangement whose incomes are at
  or below 400 percent of the federal poverty level and who are:
                           (i)  employed by a business employing 200 or
  fewer eligible individuals; or
                           (ii)  engaged in domestic service in private
  households; and
                     (B)  dependents of individuals described by
  Paragraph (A);
               (2)  the plan is operated on a nonprofit basis under the
  sponsorship of a nonprofit organization;
               (3)  covered primary care services are provided to
  enrollees by health care practitioners who:
                     (A)  have agreed to provide their services for
  free or nominal reimbursement for out-of-pocket expenses or
  expendable supplies directly related to, and incurred as a result
  of, the service provided to the enrollee; and
                     (B)  are either:
                           (i)  health care practitioners on staff of
  the sponsoring organization; or
                           (ii)  volunteer practitioners recruited
  from a county medical society;
               (4)  payments to outside contractors for marketing,
  claims administration, and similar services total not more than 10
  percent of the total charges imposed by the plan;
               (5)  the plan has received the approval and endorsement
  of the county medical society in consultation with the Texas
  Medical Association;
               (6)  except as provided by Subdivision (3), the plan
  does not pay a portion of any fees or charges imposed under the plan
  directly or indirectly as salary to an officer or director of the
  sponsoring nonprofit organization; and
               (7)  the sponsoring nonprofit organization files an
  annual report with the commissioner in the form and manner
  prescribed by the commissioner not later than the 90th day after the
  end of the corporation's fiscal year that includes:
                     (A)  the number of plan enrollees;
                     (B)  the total number of services provided under
  the plan;
                     (C)  the plan's financial statements;
                     (D)  the administrative costs and salaries paid by
  the plan; and
                     (E)  any other information reasonably requested
  by the commissioner.
         SECTION 2.  This Act takes effect September 1, 2023.