Relating to the authority of the commissioner of insurance to review rates and rate changes for certain health benefit plans. Senate Bill 1296 amends the Insurance Code to require the commissioner of insurance to establish a process under which the commissioner reviews certain health benefit plan rates and rate changes for compliance with applicable state and federal law and regulations. The bill requires the commissioner to adopt specified rules and guidance regarding individual health benefit plans and sets out additional factors the commissioner is required to consider in making a determination regarding a proposed rate for a qualified health plan, including, if the plan is in the silver level, whether the rate is appropriate for the plan in relation to the rates charged for qualified health plans offering different levels of coverage. The commissioner may consider inflation indexes and, if appropriate, medical claims trends.

Senate Bill 1296 authorizes an applicable health benefit plan issuer to offer different plan designs by rating area to individuals and small employers, provide network access beyond the geographic rating area, and offer plan designs with cost‑sharing mechanisms necessary to comply with federal actuarial values in the individual and small group market in Texas. The bill requires the commissioner to seek federal funding for the rate review program. Implementation of a provision of this bill by the Texas Department of Insurance is mandatory only if a specific appropriation is made for that purpose.