S.B. No. 53 




AN ACT
relating to the use of genetic testing information by insurers. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Section 546.002, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.002. APPLICABILITY OF CHAPTER. This chapter applies only to a [group] health benefit plan that: (1) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including: (A) an individual, [a] group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or [a] group evidence of coverage that is offered by: (i) an insurance company; (ii) a group hospital service corporation operating under Chapter 842; (iii) a fraternal benefit society operating under Chapter 885; (iv) a stipulated premium company operating under Chapter 884; or (v) a health maintenance organization operating under Chapter 843; and (B) to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a [group] health benefit plan that is offered by: (i) a multiple employer welfare arrangement as defined by Section 3 of that Act; (ii) another entity not authorized under this code or another insurance law of this state that directly contracts for health care services on a risk-sharing basis, including a capitation basis; or (iii) another analogous benefit arrangement; or (2) is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844. SECTION 2. Section 546.003, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.003. EXCEPTIONS. This chapter does not apply to: (1) a plan that provides coverage: (A) only for a specified disease; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or (D) as a supplement to liability insurance; (2) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); (3) workers' compensation insurance coverage; (4) medical payment insurance coverage provided under a motor vehicle insurance policy; or (5) a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a [group] health benefit plan as described by Section 546.002. SECTION 3. Section 546.051, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.051. CERTAIN TESTING PERMITTED; INDUCEMENT PROHIBITED. (a) A [group] health benefit plan issuer that requests an applicant for coverage under the plan to submit to a genetic test in connection with the application for coverage for a purpose not prohibited under Section 546.052 must: (1) notify the applicant that the test is required; (2) disclose to the applicant the proposed use of the test results; and (3) obtain the applicant's written informed consent before the test is administered. (b) The applicant shall state in the consent form whether the applicant elects to be informed of the test results. If the applicant elects to be informed, the person or entity that performs the test shall disclose the test results to the applicant and the [group] health benefit plan issuer. The issuer shall ensure that: (1) the applicant receives an interpretation of the test results made by a qualified health care practitioner; and (2) a physician or other health care practitioner designated by the applicant receives a copy of the test results. (c) A [group] health benefit plan issuer may not use the results of a genetic test conducted in accordance with Subsection (a) to induce the purchase of coverage under the plan. SECTION 4. Section 546.052, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.052. IMPROPER USE OF TEST RESULTS; REFUSAL TO SUBMIT TO TESTING. A [group] health benefit plan issuer may not use genetic information or the refusal of an applicant to submit to a genetic test to reject, deny, limit, cancel, refuse to renew, increase the premiums for, or otherwise adversely affect eligibility for or coverage under the plan. SECTION 5. Section 546.053, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.053. TESTING RELATED TO PREGNANCY. (a) In this section, "coerce" means to restrain or dominate a woman's free will by actual or implied: (1) force; or (2) threat of rejecting, denying, limiting, canceling, refusing to renew, or otherwise adversely affecting eligibility for coverage under a [group] health benefit plan. (b) A [group] health benefit plan issuer may not: (1) require as a condition of coverage genetic testing of a child in utero without the pregnant woman's consent; or (2) use genetic information to coerce or compel a pregnant woman to have an induced abortion. SECTION 6. Subsection (a), Section 546.101, Insurance Code, as effective April 1, 2005, is amended to read as follows: (a) An individual who submits to a genetic test has the right to know the results of the test. On the written request by the individual, the [group] health benefit plan issuer or other entity that performed the test shall disclose the test results to: (1) the individual; or (2) a physician designated by the individual. SECTION 7. Subsection (c), Section 546.102, Insurance Code, as effective April 1, 2005, is amended to read as follows: (c) This section applies to a redisclosure of genetic information by a secondary recipient of the information after disclosure of the information by an initial recipient. Except as provided by Section 546.103(b), a [group] health benefit plan issuer may not redisclose genetic information unless the redisclosure is consistent with the disclosures authorized by the tested individual under an authorization executed under Section 546.104. SECTION 8. Subsection (b), Section 546.103, Insurance Code, as effective April 1, 2005, is amended to read as follows: (b) A [group] health benefit plan issuer may redisclose genetic information without an authorization under Section 546.104: (1) for actuarial or research studies if: (A) a tested individual could not be identified in any actuarial or research report; and (B) any materials that identify a tested individual are returned or destroyed as soon as reasonably practicable; (2) to the department for the purpose of enforcing this chapter; or (3) for a purpose directly related to enabling a business decision to be made about: (A) purchasing, transferring, merging, or selling all or part of an insurance business; or (B) obtaining reinsurance affecting that insurance business. SECTION 9. Section 546.104, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.104. AUTHORIZED DISCLOSURE. An individual or an individual's legal representative may authorize disclosure of genetic information relating to the individual by an authorization that: (1) is written in plain language; (2) is dated; (3) contains a specific description of the information to be disclosed; (4) identifies or describes each person authorized to disclose the genetic information to a [group] health benefit plan issuer; (5) identifies or describes the individuals or entities to whom the disclosure or subsequent redisclosure of the genetic information may be made; (6) describes the specific purpose of the disclosure; (7) is signed by the individual or legal representative and, if the disclosure is made to claim proceeds of an affected life insurance policy, the claimant; and (8) advises the individual or legal representative that the individual's authorized representative is entitled to receive a copy of the authorization. SECTION 10. Section 546.151, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.151. CEASE AND DESIST ORDER. (a) On a finding by the commissioner that a [group] health benefit plan issuer is in violation of this chapter, the commissioner may issue a cease and desist order in the manner provided by Chapter 83. (b) If a [group] health benefit plan issuer refuses or fails to comply with a cease and desist order issued under this section, the commissioner may, in the manner provided by this code and other insurance laws of this state, revoke or suspend the issuer's certificate of authority or other authorization to operate a [group] health benefit plan in this state. SECTION 11. Section 546.152, Insurance Code, as effective April 1, 2005, is amended to read as follows: Sec. 546.152. ADMINISTRATIVE PENALTY. A [group] health benefit plan issuer that operates a plan in violation of this chapter is subject to an administrative penalty as provided by Chapter 84. SECTION 12. This Act applies only to a health benefit plan delivered, issued for delivery, or renewed on or after January 1, 2006. A health benefit plan delivered, issued for delivery, or renewed before January 1, 2006, is governed by the law as it existed immediately before the effective date of this Act, and that law is continued in effect for that purpose. SECTION 13. This Act takes effect September 1, 2005.
______________________________ ______________________________ President of the Senate Speaker of the House
I hereby certify that S.B. No. 53 passed the Senate on March 31, 2005, by the following vote: Yeas 30, Nays 0. ______________________________ Secretary of the Senate I hereby certify that S.B. No. 53 passed the House on May 20, 2005, by a non-record vote. ______________________________ Chief Clerk of the House Approved: ______________________________ Date ______________________________ Governor