This website will be unavailable from Friday, April 26, 2024 at 6:00 p.m. through Monday, April 29, 2024 at 7:00 a.m. due to data center maintenance.

 
 
  S.B. No. 1771
 
 
 
 
AN ACT
  relating to the availability and continuation of certain health
  benefit plan coverage.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle A, Title 8, Insurance Code, is amended
  by adding Chapter 1202A to read as follows:
  CHAPTER 1202A.  TEMPORARY EXTENSION OF ELECTION PERIOD FOR
  CONTINUATION OF CERTAIN COVERAGE
         Sec. 1202A.001.  EXTENSION OF ELECTION PERIOD. (a)  For the
  purposes of this section, an "extended election eligible
  individual" means an employee, member, dependent, or enrollee:
               (1)  who became eligible for continuation coverage due
  to involuntary termination, other than involuntary termination for
  cause, under Subchapter F, Chapter 1251, or Subchapter G, Chapter
  1271, at any time during the period that begins on September 1,
  2008, and ends on February 16, 2009;
               (2)  who did not elect such coverage or whose elected
  continuation coverage lapsed or was canceled without reinstatement
  for a reason other than exhaustion of the maximum period of
  continuation coverage allowable under law; and
               (3)  whose involuntary termination on which the
  eligibility is based occurred during that same period.
         (b)  Notwithstanding Section 1251.253 or 1271.301, an
  extended election eligible individual may elect continuation
  coverage under this section beginning on the effective date of S.B.
  No. 1771, Acts of the 81st Legislature, Regular Session, 2009, and
  ending on the 60th day after the date on which the notification
  required by Subsection (e) is provided to the individual.
         (c)  The period of continuation coverage for an extended
  election eligible individual who elects continuation coverage
  begins with the first period of coverage beginning on or after the
  effective date of S.B. No. 1771, Acts of the 81st Legislature,
  Regular Session, 2009, and does not extend beyond the date the
  period of continuation coverage would have ended if the coverage
  had been elected during the election period required under the law
  as it existed before the effective date of S.B. No. 1771, Acts of
  the 81st Legislature, Regular Session, 2009.
         (d)  With respect to an individual who elects continuation
  coverage under Subsection (b), the period beginning on the date the
  individual first became eligible for continuation coverage and
  ending on the first day of the 60-day election period described by
  Subsection (b) shall be disregarded for purposes of determining a
  63-day period referred to in 29 U.S.C. Section 1181(c)(2), 42
  U.S.C. Section 300gg(c)(2), 26 U.S.C. Section 9801(c)(2), and
  Sections 846.202(d), 1501.102, and 1506.001(8).
         (e)  Not later than the 60th day after the effective date of
  S.B. No. 1771, Acts of the 81st Legislature, Regular Session, 2009,
  an employer or group policy or contract holder shall provide notice
  to any former employee, member, dependent, or enrollee who is an
  extended election eligible individual that includes:
               (1)  a description of the extended election period
  available to the individual under this section;
               (2)  a description, displayed in a prominent manner, of
  the individual's right to a reduced premium and any conditions on
  entitlement to the reduced premium under the American Recovery and
  Reinvestment Act of 2009 (Pub. L. No. 111-5);
               (3)  a form that allows the individual to request
  treatment as an assistance eligible individual, as defined by the
  American Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5),
  to whom the premium subsidy would apply;
               (4)  the amount continuation coverage will cost and the
  period of coverage available;
               (5)  an election form that includes the return address
  and the due date for making the election; and
               (6)  notice that if the individual is entitled to the
  reduced premium and later becomes eligible for other group health
  plan coverage or Medicare, the individual must notify the employer
  in writing or the individual may be subject to a tax penalty.
         Sec. 1202A.002.  EXPIRATION OF CHAPTER. This chapter
  expires September 1, 2013.
         SECTION 2.  Section 1251.253, Insurance Code, is amended to
  read as follows:
         Sec. 1251.253.  REQUEST FOR CONTINUATION OF GROUP COVERAGE.
  An employee, member, or dependent must provide to the employer or
  group policyholder a written request for [in writing the]
  continuation of group coverage not later than the 60th [31st] day
  after the later of:
               (1)  the date the group coverage would otherwise
  terminate; or
               (2)  the date the individual is given, in a format
  prescribed by the commissioner, notice by either the employer or
  the group policyholder of the right to continuation of group
  coverage.
         SECTION 3.  Section 1251.254, Insurance Code, is amended to
  read as follows:
         Sec. 1251.254.  PAYMENT OF CONTRIBUTIONS. Except as
  provided by this section, an [(a) An] employee, member, or
  dependent who elects to continue group coverage under this
  subchapter must pay to the employer or group policyholder[,] each
  month [in advance,] the amount of contribution required by the
  employer or policyholder, plus two percent of the group rate for the
  coverage being continued under the group policy [on the due date of
  each payment]. A payment under this section must be made not later
  than the 45th day after the date of the initial election for
  coverage and on the due date of each payment thereafter. Following
  the first payment made after the initial election for coverage, the
  payment of any other premium shall be considered timely if made on
  or before the 30th day after the date on which the payment is due.
         [(b)     The employee's, member's, or dependent's written
  election for continuation of group coverage, together with the
  first contribution required to establish advance monthly
  contributions, must be given to the employer or policyholder not
  later than the later of:
               [(1)     the 31st day after the date coverage would
  otherwise terminate; or
               [(2)     the date the individual is given notice by either
  the employer or the group policyholder of the right to continuation
  of group coverage.]
         SECTION 4.  Section 1251.255, Insurance Code, is amended to
  read as follows:
         Sec. 1251.255.  TERMINATION OF CONTINUED COVERAGE.
  (a)  Group coverage continued under this subchapter may not
  terminate until the earliest of:
               (1)  the date the maximum continuation period provided
  by law would end, which is:
                     (A)  for any employee, member, or dependent not
  eligible for continuation coverage under Title X, Consolidated
  Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161
  et seq.) (COBRA), nine [six] months after the date the employee,
  member, or dependent elects to continue the group coverage; or
                     (B)  for any employee, member, or dependent
  eligible for continuation coverage under COBRA, six additional
  months following any period of continuation coverage provided under
  COBRA;
               (2)  the date failure to make timely payments would
  terminate the group coverage;
               (3)  the date the group coverage terminates in its
  entirety;
               (4)  the date the insured is or could be covered under
  Medicare;
               (5)  the date the insured is covered for similar
  benefits by another plan or program, including:
                     (A)  a hospital, surgical, medical, or major
  medical expense insurance policy;
                     (B)  a hospital or medical service subscriber
  contract; or
                     (C)  a medical practice or other prepayment plan;
               (6)  the date the insured is eligible for similar
  benefits, whether or not covered for those benefits, under any
  arrangement of coverage for individuals in a group, whether on an
  insured or uninsured basis; or
               (7)  the date similar benefits are provided or
  available to the insured under any state or federal law other than
  continuation coverage under Title X, Consolidated Omnibus Budget
  Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)
  (COBRA).
         (b)  Not later than the 30th day before the end of the
  continuation period described by Subsection (a)(1) that is
  applicable to the individual [six months after the date the
  employee, member, or dependent elects to continue group coverage
  under the policy], the insurer shall:
               (1)  notify the individual that the individual may be
  eligible for coverage under the Texas Health Insurance Risk Pool as
  provided by Chapter 1506; and
               (2)  provide to the individual the address for applying
  to that pool.
         SECTION 5.  Section 1271.302, Insurance Code, is amended to
  read as follows:
         Sec. 1271.302.  REQUEST FOR CONTINUED COVERAGE; DEADLINE.
  An enrollee must provide to the employer or group contract holder
  [make] a written notice of election to continue group coverage
  under this subchapter [and pay the first contribution required to
  establish contributions on an advance monthly basis to the employer
  or group contract holder] not later than the 60th [31st] day after
  the later of:
               (1)  the date the group coverage would otherwise
  terminate; or
               (2)  the date the enrollee is given notice of the right
  of continuation by the employer or group contract holder.
         SECTION 6.  Subsection (b), Section 1271.303, Insurance
  Code, is amended to read as follows:
         (b)  The enrollee must make the payment not later than the
  45th day after the initial election for coverage and on the due date
  of each payment thereafter. Following the first payment made after
  the initial election for coverage, the payment of any other premium
  shall be considered timely if made by the 30th day after the date on
  which payment is due [in advance on a monthly basis on the due date
  of each payment].
         SECTION 7.  Section 1271.304, Insurance Code, is amended to
  read as follows:
         Sec. 1271.304.  TERMINATION OF CONTINUED COVERAGE.  Group
  continued coverage under this subchapter may not terminate until
  the earliest of:
               (1)  the date the maximum continuation period provided
  by law would end, which is:
                     (A)  for any enrollee not eligible for
  continuation coverage under Title X, Consolidated Omnibus Budget
  Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)
  (COBRA), the end of the nine-month [six-month] period after the
  date the election to continue coverage is made; or
                     (B)  for any enrollee eligible for continuation
  coverage under COBRA, six additional months following any period of
  continuation provided under that statute;
               (2)  the date on which failure to make timely payments
  terminates coverage;
               (3)  the date on which the enrollee is covered for
  similar services and benefits by any other plan or program,
  including a hospital, surgical, medical, or major medical expense
  insurance policy, hospital or medical service subscriber contract,
  or medical practice or other prepayment plan; or
               (4)  the date on which the group coverage terminates in
  its entirety.
         SECTION 8.  Subsection (a), Section 1271.305, Insurance
  Code, is amended to read as follows:
         (a)  At least 30 days before the end of the continuation
  [six-month] period described by Section 1271.304(1) that is
  applicable to the enrollee [after the date an enrollee elects to
  continue group coverage], the health maintenance organization
  shall notify the enrollee that the enrollee may be eligible for
  coverage under the Texas Health Insurance Risk Pool as provided by
  Chapter 1506.
         SECTION 9.  Section 1506.153, Insurance Code, is amended by
  adding Subsections (c) and (d) to read as follows:
         (c)  An individual eligible for benefits from the
  continuation of coverage under Subchapter F or G, Chapter 1251, or
  Subchapter G, Chapter 1271, who did not elect continuation coverage
  during the election period, or whose elected continuation coverage
  lapsed or was canceled without reinstatement, is eligible for pool
  coverage.  Eligibility under this subsection is subject to a
  180-day exclusion of coverage under Section 1506.155(a-1).
         (d)  The 180-day exclusion of coverage provided under
  Subsection (c) does not apply to an individual eligible for
  benefits from the continuation of coverage under Subchapter F or G,
  Chapter 1251, or Subchapter G, Chapter 1271, who did not elect
  continuation coverage during the election period, or whose elected
  continuation coverage lapsed or was canceled without
  reinstatement, following a period of continuation coverage under
  Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29
  U.S.C. Section 1161 et seq.) (COBRA).
         SECTION 10.  Subsection (a-1), Section 1506.155, Insurance
  Code, is amended to read as follows:
         (a-1)  Except as provided by Section 1506.056, pool coverage
  for an individual eligible pursuant to Section 1506.153(b) or (c)
  excludes charges or expenses incurred before the expiration of 180
  days from the effective date of coverage with regard to any
  condition for which:
               (1)  the existence of symptoms would cause an
  ordinarily prudent person to seek diagnosis, care, or treatment
  within the six-month period preceding the effective date of
  coverage; or
               (2)  medical advice, care, or treatment was recommended
  or received during the six-month period preceding the effective
  date of coverage.
         SECTION 11.  (a)  Sections 1251.253 and 1271.302, Insurance
  Code, as amended by this Act, apply only to:
               (1)  a request for continuation of group coverage that
  an employee, member, dependent, or enrollee becomes eligible to
  make on or after the effective date of this Act; or
               (2)  a request for continuation of group coverage that
  an employee, member, dependent, or enrollee became eligible to make
  before the effective date of this Act, provided that the election
  period available to the employee, member, dependent, or enrollee
  under Section 1251.253 or 1271.302, Insurance Code, as those
  sections existed before amendment by this Act, has not expired as of
  the effective date of this Act.
         (b)  A request for continuation of group coverage that an
  employee, member, dependent, or enrollee became eligible to make
  before the effective date of this Act and that, on the effective
  date of this Act, the employee, member, dependent, or enrollee is no
  longer eligible to make, is governed by the law as it existed before
  the effective date of this Act, and that law is continued in effect
  for that purpose. This subsection does not apply to an employee,
  member, dependent, or enrollee who is an extended election eligible
  individual to whom Chapter 1202A, Insurance Code, as added by this
  Act, applies.
         SECTION 12.  Sections 1251.254 and 1271.303, Insurance Code,
  as amended by this Act, apply only to a payment for continuation
  coverage required to be made on or after the effective date of this
  Act. A payment for continuation coverage required to be made before
  the effective date of this Act is governed by the law as it existed
  before that date, and that law is continued in effect for that
  purpose.
         SECTION 13.  Sections 1251.255 and 1271.304, Insurance Code,
  as amended by this Act, apply to coverage for which an election to
  continue was made on or after the effective date of this Act.
         SECTION 14.  This Act takes effect immediately if it
  receives a vote of two-thirds of all the members elected to each
  house, as provided by Section 39, Article III, Texas Constitution.
  If this Act does not receive the vote necessary for immediate
  effect, this Act takes effect September 1, 2009.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1771 passed the Senate on
  April 14, 2009, by the following vote:  Yeas 30, Nays 0.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1771 passed the House on
  May 26, 2009, by the following vote:  Yeas 144, Nays 0, one
  present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor