or program heretofore or hereafter established or maintained by an employer or by an employee organization, or by both, to the extent that such plan. fimd, or program was estabIish8d or is maintained for the purpose of providing for its participants.. . through tbepurdUscofimlmmcc orothawise,dmtalcarebenefitsinthceventofaccidentor d~"Thed~~of"~~beaefitpkn"isbrosd~isdearlyootiimitedto . tndibmdbealthburanceplans. Wecondudethatartide21.53appliestoasingle-
the evas of&dent or sickness."
You also ask whether ELBA preempt able 1% tide 3.51-9, and &de 21.53 of the Inwranw Code. YouatatetbatyoutmdaSid "thatERISApmempts t~lprovidonr . ..utheyrpp~tomoddaglaanployer.#Il-fimdedplans."J~Asyou aote,howevqERISAdoesnotapplyto "govanmmtalP~k~establishedby gov8wmaItaI elltltk. see 29 U.S.C. 80 1-2) (definhg the tam "govamaa phll" toindudeaplancstablished"foritsanployees"by"thc -0fanyStateor pow& sIhbision thuwf"), 1003@)(t) ("The plwisions ofthis subdlapt8r ahall 'lot @Y to my amployee bet@ plan if...such plan is a w plan"). ~~younrggedthatERISA~these~~oftheInsuranceCodeas theyapplyt0singleunp1oyel. t?eHimdedg-plans.
ERlSA's preemption provision generally states that an employee benefit plan is not "~insunacecompMyorothaiasura,~tnutcompany.oriwestmentcomp~ or . ..algagedinthebUinessofinsumMz orbankingforpurposesofanylawofany Statepurpohgtoregulateinsurmx companies. --,banks.trust companie or illvamm wmpani8s." Id. 5 1144(b). This preen@on provision
p. 1446 Mr. David Florcs - Page 4 (DM-276)
expre& exdudes, however, employee benefit plans which are exenqt under section 1003(b). w&h includes govamnanal plans. See id. In short, ERISA exempts gowmmntd plans &m~ its requiremen& id. 0 NJO3@),and expressly provides that it does not preempt state laws which govern such plans, ti. 8 1144(b). Therefo~ we conclude that WSA does not preempt artide 1.24C. article 3.51-9, and artide 21.53 of the Insurance code to the extent they apply to a single-employer, self-funded plan of a governmental enthy such as the county.4
Next you ask us to "co&m [yourl understanding"that article 3.51-6, section 3A and article 3.51-14s of the Texas Insurance Code "which arguably apply to single- employer, selfXimdedplans do not require employers to provide certain be&fits." You suggest that these provisions "do not require employers to provide cutain benefits, but rather require imrers, MEWA'sand other seUers of employee benefit plans to offer to provide certain coverage, and the employer may or may not elect to provide this coverage to its anploye8s."
S§ion (a) ofaection 3A ofartide 3.51-6 reqGres vmious hlSW8lSMdplMStO "@randmakeawilabk...cowagefor sewicesandbenefitsonanexpenreiuxred, savice,orprcpaidbasisfbrout-pati~expawsthatrnayarisefrominvitrofert%a&n~ ploccdurrs"iftll8plicyorplan"othendwplovideP pregMwy-rdatal beae6ts. Subsectioa@)rtatesthat"[a]no~madeundasUbsectioa(a)~afthir~~ to this section" Subsection (c) provides that a "rejection of an offer to provide ooverage ikr services or bendits proviaed by Subsection (a) ofthis se&on must be in writing."
Section 3A of article 3.51-6 states that covaage must be ofGred to "ea& group policyholder, contrau holder, empkym, multiple-employer, union, aswdation, or
p. 1447 Mr. David Florcs - Page 5 W-276)
trustee." Ins. Code art. 3.516, 8 3A(a) (anphasis added). It does. not require that covaage be off&reddirectly to an empbyee, Tbcrefore, we wndude that section 3A requires a. singlcunployer, self-tided plan to offer coverage for in vitro f-on procedures to the employec6
Article 3.5-14, which is similarto article 3.51-6, provides as follows: Each insurer, nonprofit hospital service plan corpora- tion . . . , health maintenam organization. . . , employer, multiple employer, union, association, trustee, or other seHmded or se% insured welhre or benefit plan, program. or arrangement that issues group health insurance policies, enters into health care service contracts or plans, or provides