QBffiteof the SIttornep 4Benerat Watt of QtexaS DAN MORALES .4rrORSEx GENERAL Decrmba 17.1993
Mr. David U. Flares OpinionNo. DM-276 Wilhmson County Auditor P.O. Box 506 Be: wlletller a camtfs singl~loya Cieorgetom, Texas 78627 self4mded medical benefit plan is subject to certain provisions of the Insurance Code, and related questions (RQ-508)
Dear Mr. Plores:
Youbeginbyaskiogwhetheftbe~smedicalbene6tplallissubjeutocutain ~~oftheTarasInnvanceCode~ifw,~~~provisioruue pampted by tile federal Bmployee Retkma Income security AL% 29 U.S.C. Qp 1001 - 1461 ("BRISK"). Fii we address whether article 1.24C, tide 3.51-g. and artide 21.53 of the Inswnce Code apply to singleunployer, self%mded plans.
Artide124C(a)statesthatthetbeofthisatticleis toassuredlatadeqwtelledth iworwccandbene6tscovaageis avaWletotbecitkuofthisrtate,torssuntbatadequatehealtb
p. 1444 Mr. David Rores - Page 2 m-2791
care is available to protect the public health and salty, -and to ascMaintheco~effactofHIvandAlDsonhealthinslJrance coverage and health benefits CoyeraBeavailability and adequacy in this state for purposes of meeting the public%health coverage needs. Subsections (c) through (i) of the article require the State Board of Insuranw (the "board") to gather and compile data on the efkct of HIV and AIDS on health insurance coverage, and authorize the board to submit written recommendations for legislation to resolve prob1em.saswdated with the impact of HIV and AIDS on the availabiity health insurww coverage. ln article 1.24C. "health insursnce coverage"is de&d to mean "any group policy, contmct, or ccrtiticate of health insurance or be&its deliied, issued for delivay.orrarewedinthisstatebyaoiDsurancecompany..., a group hospital service corporation. . _, a health maintenanceorganization. . . , and q~ sel@wmmce bust or mechanismproviding kalfh care benefirs Ins. Code art. 1.24C(b)(2) (citation omitted) (qhasis added).
'You ask whether the italidz.ed language would indude a singlaanploya sdf- fundedpknruch~Stbeswithiatheambitofthe~de. Yousuggestthatbecause th8Inwrwcecod8gulemny8ppliesonlyto inwrwc8compwieqgroup~service . ~alldheabhmaintenanceorgaainrtionrandtbatthe~oflasunnces regulataya+nityis~limitedtoth&eindusGes,thekgislaWcarldnothave intended for artide L24C to apply to singl&employer,seMmded plans. As will be seen below,tbelegislahveonammrbaofoccesioruhas~~p~~.oftht lnsumnw Code appkable to self-funded plans. For this reason, and because a single employq aeX%mdekplan is dearly a "mech&m p&ding @alth care beM%s," we condude that article 124C applies to aingku@oyer'&fimded ~plaassuch as the COUllt+.=
Next, you sddder article 3.51-g appIies to single-employer,self-fbnded plans. Artide 3.51-g re@ires various entities, induding "all employer, trustee, or other serf- fMderl or seSnsud plans or anangements WanwAg health insurance or providing ofher healfh coverage cr services" to provide ,%ene&s for the necessuy care and tmtment of chemical dependency that are not less favorable than fbr physical illness generally." Id. art. 3.51-g. 8 2A(a) (emphasis added). Although this provision expressly
p. 1445 Mr. David Flares - Page 3 (DM-276)
refers to seKiimded plans, you suggest that it may only be designed to -applyto multiple employer we&e arrangements ("MEWA's")"which,while being a collection of employee -plans,= insuranceintheKnsethatriskisspreadwasmralunrelatedentities." Taaaiicizedknguage~howeva,makesd~thatthisprovisionappliesnotonlyto iremake plans but also to self4mded plans that provide "other health coverage or services." Therefore, we conclude that article 3.51-g applies to single-anployer, self- fimded plans such as the counQ+s.
In addition, you ask whether article 21.53. which governs dentsl care benefits in catain w appks to a singbempbyer, sdf%mded PIED.Article 2 1.S3 applies to a "health insumxe policy" or "employee bcneiit plan" as de&d by section 1. subsdons (a) and (b). Tbe term "employee benefit plan" means "any plan, fund