By: Driver H.B. No. 2662
73R5684 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to standards for long-term care insurance policies.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 3, Article 3.70-12, Insurance Code, is
1-5 amended to read as follows:
1-6 Sec. 3. Minimum standards for long-term care insurance.
1-7 (a) The State Board of Insurance by rule shall establish specific
1-8 standards for provisions of long-term care insurance policies and
1-9 standards for full and fair disclosure setting forth the manner,
1-10 content, and required disclosures for the marketing and sale of
1-11 long-term care insurance policies. Those standards are in addition
1-12 to and in accordance with applicable laws of this state, including
1-13 Subchapter G of Chapter 3 of this code, applicable federal law, and
1-14 any rules, regulations, and standards required by federal law.
1-15 (b) The standards established under Subsection (a) of this
1-16 section shall cover the following:
1-17 (1) terms of renewability;
1-18 (2) initial and subsequent conditions of eligibility;
1-19 (3) nonduplication of coverage;
1-20 (4) coverage of dependents;
1-21 (5) preexisting conditions;
1-22 (6) termination of insurance;
1-23 (7) continuation or conversion;
1-24 (8) probationary periods;
2-1 (9) benefit limitations, exceptions, and reductions;
2-2 (10) elimination periods;
2-3 (11) requirements for replacement;
2-4 (12) recurrent conditions;
2-5 (13) definitions of terms; and
2-6 (14) inflation protection.
2-7 (c) The standards established under Subsection (a) of this
2-8 section may:
2-9 (1) establish standard claim and policy forms;
2-10 (2) require coverage for:
2-11 (A) skilled nursing care;
2-12 (B) intermediate nursing care;
2-13 (C) custodial care; and
2-14 (D) home health care;
2-15 (3) require that premium rates may not be raised for a
2-16 covered individual unless the increase is made for all members of
2-17 the class to which the individual has been assigned by the insurer;
2-18 (4) require an insurer to pay for services covered by
2-19 the policy that are rendered by any institution licensed to provide
2-20 those services under Chapter 242, Health and Safety Code; and
2-21 (5) require a health maintenance organization to
2-22 permit participation by any institution licensed to provide
2-23 services covered under the evidence of coverage under Chapter 242,
2-24 Health and Safety Code.
2-25 (d) <(b)> Any rules issued by the State Board of Insurance
2-26 under this section shall include requirements no less favorable
2-27 than the minimum standards of benefits for long-term care insurance
3-1 adopted in any model laws or regulations relating to minimum
3-2 standards for benefits for long-term care insurance and mandated by
3-3 federal law.
3-4 (e) <(c)> In addition to other provisions of this section, a
3-5 long-term care insurance policy or certificate subject to this
3-6 article may not contain a provision which denies a claim for losses
3-7 incurred more than six months from the effective date of coverage
3-8 for a preexisting condition. A policy may not define a preexisting
3-9 condition more restrictively than a condition for which medical
3-10 advice was given or treatment was recommended by or received from a
3-11 physician within six months before the effective date of coverage.
3-12 The State Board of Insurance by rule may provide for additional
3-13 reasonable regulation of preexisting conditions consistent with
3-14 this section. That authority includes the authority to extend the
3-15 limitations periods set forth in this section as to specific age
3-16 group categories in specific policy forms, based on the board's
3-17 first finding that such an extension is in the best interest of the
3-18 public.
3-19 SECTION 2. The importance of this legislation and the
3-20 crowded condition of the calendars in both houses create an
3-21 emergency and an imperative public necessity that the
3-22 constitutional rule requiring bills to be read on three several
3-23 days in each house be suspended, and this rule is hereby suspended,
3-24 and that this Act take effect and be in force from and after its
3-25 passage, and it is so enacted.