While 2010 is not a legislative session year, Texas’ 81st Legislature Regular Session gave insurance professionals around the state several items to implement this year. The main focus seemed to be specific legislation designed to help reduce the growing numbers of uninsured Texans. Some of the “high-impact” bills are important enough for every agent licensed in Texas to know. Two Medicare Advantage sales education requirements were also added in an effort to provide consumers with long-term representative relationships.
- S.B. 78: Referred to as “Healthy Texas,” this bill created a reimbursement for employer groups offering medical coverage for their employees. The employer must not have offered benefits over the last 12 months, have at least 30 percent of their employees at or below 300 percent federal poverty level, contribute at least 50 percent of the premiums, and obtain 60 percent employee participation. This is an excellent way to encourage more employers to offer coverage and reduce the the number of uninsured residents.
- S.B. 79: Created a voluntary specialty certification program for agents who focus on small-employer group health. Requirements include eight initial hours of continuing education, followed by five hours of small-group specific CE hours per year. The Texas Department of Insurance (TDI) will post small-group certified insurance agents on its website, providing employers an way to find qualified professionals to help them create benefit packages. The Texas Association of Health Underwriters developed an approved eight-hour course and exam and has certified more than 300 small-group agents since May 2010.
- S.B. 80: Introduced by Sen. Jane Nelson, this created a new 100 percent employer contribution funding option. This bill took effect on Jan. 1, 2010 and allowed health insurance carriers to create a funding option for groups paying 100 percent of the employee premium. When employers choose this funding option, it will encourage and often result in 100 percent participation by employees, thus reducing the numbers of uninsured.
- S.B. 1771/H.B. 2453: Released by both the Senate and the House, this bill extends state continuation to nine months for groups with fewer than 20 employees and and which are not COBRA-eligible. The bill also increases the election window from 31 to 60 days to match the COBRA election window. While this bill would appear to have minimal impact, the true cost is yet to be realized. In most cases, people will only elect COBRA if they have an ongoing medical condition. The limited amount of additional premiums will not make up the cost of claims ,which could have a long-lasting effect for the carriers.
- H.B. 2064: This bill will take effect Jan. 1, 2011, and will provide premium discounts for individuals covered under the Texas Health Insurance Pool with incomes at or below 300 percent of the federal poverty level. The health pool operators are using 2010 to gather data to determine who will qualify and at what percentage the discounts will be.
- H.B. 739: The bill applies to licenses issued or renewed on or after April 1, 2010. It requires agents selling Medicare Advantage to obtain eight initial hours of Medicare-based continuing education, with four required hours in subsequent years. The requirement is for both grandfathered and non-grandfathered licensed agents. H.B. 2456 followed up with granting the TDI to require product-specific CE for certain “complex” insurance products, including but not limited to annuities and senior products.
In addition to these bills, five mandates of significant importance were also signed into law.
- Coverage for orthotic, prosthetic devices (H.B. 806)
- Coverage for routine patient care for people in clinical trials who have a life threatening disease or condition (S.B. 39)
- Coverage for oral administration of special formula required for children with specific allergies (H.B. 2000)
- Autism coverage expansion requiring coverage for children from birth to age 10 (H.B .451)
- A bill providing benefit screening for cardiovascular disease for males ages 45-76 and females ages 55-76, diabetics, and others determined to be at risk. The benefit is capped at $200 per screening every five years (H.B. 1290)
Rusty Rice is the past president of the Texas Association of Health Underwriters. He can be reached at [email protected].