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