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A BILL TO BE ENTITLED
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AN ACT
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relating to the recovery from third parties by health benefit plan |
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issuers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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by adding Chapter 1220 to read as follows: |
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CHAPTER 1220. HEALTH BENEFIT PLAN ISSUER'S RECOVERY FROM THIRD |
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PARTIES |
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Sec. 1220.001. DEFINITION. In this chapter, "health |
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benefit plan" means a plan that provides benefits for medical or |
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surgical expenses incurred as a result of a health condition, |
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accident, or sickness, including an individual, group, blanket, or |
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franchise insurance policy or insurance agreement, a group hospital |
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service contract, or an individual or group evidence of coverage or |
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similar coverage document. The term includes, to the extent |
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allowed by other law, a plan described by 29 U.S.C. Section 1003(b). |
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Sec. 1220.002. RECOVERY FROM THIRD PARTIES. (a) A health |
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benefit plan that provides that the plan issuer has a right of |
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recovery from a third party for injury suffered by a covered |
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individual, whether by subrogation, reassignment, or |
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reimbursement: |
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(1) must provide that the right of recovery is |
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subordinate to the covered individual's right to be fully |
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compensated for damages incurred; and |
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(2) must obligate the plan issuer to share in the legal |
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expenses incurred by the covered individual in obtaining recovery |
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from a third party to the same extent that the issuer shares in any |
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recovery from the third party. |
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(b) The health benefit plan issuer may not pursue a right of |
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subrogation against a covered individual's first party coverage. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2010. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2010, |
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is covered by the law in effect at the time the health benefit plan |
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was delivered, issued for delivery, or renewed, and that law is |
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continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2009. |