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AN ACT
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relating to requirements regarding employer liability for certain |
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group health benefit plan premiums and to a health benefits study to |
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be conducted by the Texas Department of Insurance. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 843.210, Insurance Code, is amended to |
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read as follows: |
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Sec. 843.210. TERMS OF ENROLLEE ELIGIBILITY. (a) A |
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contract between a health maintenance organization and a group |
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contract holder must provide that: |
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(1) in addition to any other premiums for which the |
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group contract holder is liable, the group contract holder is |
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liable for an enrollee's premiums from the time the enrollee is no |
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longer part of the group eligible for coverage under the contract |
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until the end of the month in which the contract holder notifies the |
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health maintenance organization that the enrollee is no longer part |
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of the group eligible for coverage by the contract; and |
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(2) the enrollee remains covered by the contract until |
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the end of that period. |
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(b) Each health maintenance organization that enters into a |
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contract described by Subsection (a) shall notify the group |
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contract holder periodically as provided by this section that the |
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contract holder is liable for premiums on an enrollee who is no |
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longer part of the group eligible for coverage under the contract |
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until the health maintenance organization receives notification of |
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termination of the enrollee's eligibility for that coverage. |
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(c) If the health maintenance organization charges the |
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group contract holder on a monthly basis for the coverage premiums, |
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the health maintenance organization shall include the notice |
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required by Subsection (b) in each monthly statement sent to the |
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group contract holder. If the health maintenance organization |
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charges the group contract holder on other than a monthly basis for |
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the premiums, the health maintenance organization shall notify the |
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group contract holder periodically in the manner prescribed by the |
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commissioner by rule. |
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(d) The notice required by Subsection (b) must include a |
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description of methods preferred by the health maintenance |
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organization for notification by a group contract holder of an |
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enrollee's termination from coverage eligibility. |
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SECTION 2. Section 1301.0061, Insurance Code, is amended to |
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read as follows: |
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Sec. 1301.0061. TERMS OF ENROLLEE ELIGIBILITY. (a) A |
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contract between an insurer and a group policyholder under a |
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preferred provider benefit plan must provide that: |
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(1) in addition to any other premiums for which the |
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group policyholder is liable, the group policyholder is liable for |
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an individual insured's premiums from the time the individual is no |
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longer part of the group eligible for coverage under the policy |
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until the end of the month in which the policyholder notifies the |
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insurer that the individual is no longer part of the group eligible |
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for coverage under the policy; and |
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(2) the individual remains covered under the policy |
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until the end of that period. |
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(b) Each insurer that enters into a contract described by |
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Subsection (a) shall notify the group policyholder periodically as |
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provided by this section that the policyholder is liable for |
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premiums on an individual who is no longer part of the group |
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eligible for coverage until the insurer receives notification of |
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termination of the individual's eligibility for coverage. |
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(c) If the insurer charges the group policyholder on a |
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monthly basis for the premiums, the insurer shall include the |
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notice required by Subsection (b) in each monthly statement sent to |
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the group policyholder. If the insurer charges the group |
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policyholder on other than a monthly basis for the premiums, the |
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insurer shall notify the group policyholder periodically in the |
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manner prescribed by the commissioner by rule. |
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(d) The notice required by Subsection (b) must include a |
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description of methods preferred by the insurer for notification by |
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a group policyholder of an individual's termination from coverage |
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eligibility. |
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SECTION 3.. Subchapter B, Chapter 32, Insurance Code, is |
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amended by adding Section 32.0221, to read as follows: |
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Sec. 32.0221. TEXAS HEALTH BENEFITS STUDY. (a) The |
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department shall study the disparity in patient copayments between |
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orally and intravenously administered chemotherapies, the reasons |
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for the disparity, and the patient benefits in establishing |
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copayment parity between oral and infused chemotherapy agents. |
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(b) Not later than August 1, 2010, the department shall |
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submit to the governor, the lieutenant governor, the speaker of the |
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house of representatives, and the appropriate standing committees |
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of the legislature a report regarding the results of the study |
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conducted under Subsection (a), together with any recommendation |
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for legislation. |
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SECTION 4. The change in law made by Section 1 and 2 of this |
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Act applies only to a contract between an insurer or health |
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maintenance organization and a group policy or contract holder that |
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is entered into or renewed on or after January 1, 2010. A contract |
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entered into or renewed before January 1, 2010, is governed by the |
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law in effect immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 5. This Act takes effect September 1, 2009. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 1143 passed the Senate on |
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April 2, 2009, by the following vote: Yeas 31, Nays 0; and that the |
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Senate concurred in House amendment on May 30, 2009, by the |
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following vote: Yeas 31, Nays 0. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 1143 passed the House, with |
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amendment, on May 26, 2009, by the following vote: Yeas 111, |
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Nays 31, two present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |