1-1 By: Leedom S.B. No. 888
1-2 (In the Senate - Filed March 11, 1993; March 15, 1993, read
1-3 first time and referred to Committee on Economic Development;
1-4 April 21, 1993, reported favorably by the following vote: Yeas 9,
1-5 Nays 0; April 21, 1993, sent to printer.)
1-6 COMMITTEE VOTE
1-7 Yea Nay PNV Absent
1-8 Parker x
1-9 Lucio x
1-10 Ellis x
1-11 Haley x
1-12 Harris of Dallas x
1-13 Harris of Tarrant x
1-14 Leedom x
1-15 Madla x
1-16 Rosson x
1-17 Shapiro x
1-18 Wentworth x
1-19 A BILL TO BE ENTITLED
1-20 AN ACT
1-21 relating to standards for long-term care insurance policies.
1-22 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-23 SECTION 1. Section 3, Article 3.70-12, Insurance Code, is
1-24 amended to read as follows:
1-25 Sec. 3. Minimum standards for long-term care insurance.
1-26 (a) The State Board of Insurance by rule shall establish specific
1-27 standards for provisions of long-term care insurance policies and
1-28 standards for full and fair disclosure setting forth the manner,
1-29 content, and required disclosures for the marketing and sale of
1-30 long-term care insurance policies. Those standards are in addition
1-31 to and in accordance with applicable laws of this state, including
1-32 Subchapter G of Chapter 3 of this code, applicable federal law, and
1-33 any rules, regulations, and standards required by federal law.
1-34 (b) The standards established under Subsection (a) of this
1-35 section shall cover the following:
1-36 (1) terms of renewability;
1-37 (2) initial and subsequent conditions of eligibility;
1-38 (3) nonduplication of coverage;
1-39 (4) coverage of dependents;
1-40 (5) preexisting conditions;
1-41 (6) termination of insurance;
1-42 (7) continuation or conversion;
1-43 (8) probationary periods;
1-44 (9) benefit limitations, exceptions, and reductions;
1-45 (10) elimination periods;
1-46 (11) requirements for replacement;
1-47 (12) recurrent conditions;
1-48 (13) definitions of terms; and
1-49 (14) inflation protection.
1-50 (c) The standards established under Subsection (a) of this
1-51 section may:
1-52 (1) establish standard claim and policy forms;
1-53 (2) require coverage for:
1-54 (A) skilled nursing care;
1-55 (B) intermediate nursing care;
1-56 (C) custodial care; and
1-57 (D) home health care;
1-58 (3) require that premium rates may not be raised for a
1-59 covered individual unless the increase is made for all members of
1-60 the class to which the individual has been assigned by the insurer;
1-61 (4) require an insurer to pay for services covered by
1-62 the policy that are rendered by any institution licensed to provide
1-63 those services under Chapter 242, Health and Safety Code; and
1-64 (5) require a health maintenance organization to
1-65 permit participation by any institution licensed to provide
1-66 services covered under the evidence of coverage under Chapter 242,
1-67 Health and Safety Code.
1-68 (d) <(b)> Any rules issued by the State Board of Insurance
2-1 under this section shall include requirements no less favorable
2-2 than the minimum standards of benefits for long-term care insurance
2-3 adopted in any model laws or regulations relating to minimum
2-4 standards for benefits for long-term care insurance and mandated by
2-5 federal law.
2-6 (e) <(c)> In addition to other provisions of this section, a
2-7 long-term care insurance policy or certificate subject to this
2-8 article may not contain a provision which denies a claim for losses
2-9 incurred more than six months from the effective date of coverage
2-10 for a preexisting condition. A policy may not define a preexisting
2-11 condition more restrictively than a condition for which medical
2-12 advice was given or treatment was recommended by or received from a
2-13 physician within six months before the effective date of coverage.
2-14 The State Board of Insurance by rule may provide for additional
2-15 reasonable regulation of preexisting conditions consistent with
2-16 this section. That authority includes the authority to extend the
2-17 limitations periods set forth in this section as to specific age
2-18 group categories in specific policy forms, based on the board's
2-19 first finding that such an extension is in the best interest of the
2-20 public.
2-21 SECTION 2. The importance of this legislation and the
2-22 crowded condition of the calendars in both houses create an
2-23 emergency and an imperative public necessity that the
2-24 constitutional rule requiring bills to be read on three several
2-25 days in each house be suspended, and this rule is hereby suspended,
2-26 and that this Act take effect and be in force from and after its
2-27 passage, and it is so enacted.
2-28 * * * * *
2-29 Austin,
2-30 Texas
2-31 April 21, 1993
2-32 Hon. Bob Bullock
2-33 President of the Senate
2-34 Sir:
2-35 We, your Committee on Economic Development to which was referred
2-36 S.B. No. 888, have had the same under consideration, and I am
2-37 instructed to report it back to the Senate with the recommendation
2-38 that it do pass and be printed.
2-39 Lucio,
2-40 Vice-Chairman
2-41 * * * * *
2-42 WITNESSES
2-43 FOR AGAINST ON
2-44 ___________________________________________________________________
2-45 Name: Elizabeth Little x
2-46 Representing: AARP
2-47 City: Austin
2-48 -------------------------------------------------------------------
2-49 Name: Tom Bond x
2-50 Representing: Texas HMO Association
2-51 City: Austin
2-52 -------------------------------------------------------------------
2-53 Name: Erwin Lenet x
2-54 Representing: TX Silver Haired Legislature
2-55 City: Dallas
2-56 -------------------------------------------------------------------
2-57 Name: Jack Ratkovic x
2-58 Representing: TSHL
2-59 City: Corpus Christi
2-60 -------------------------------------------------------------------
2-61 FOR AGAINST ON
2-62 ___________________________________________________________________
2-63 Name: William S. McCaffrey x
2-64 Representing: TX Silver Haired Legislature
2-65 City: Temple
2-66 -------------------------------------------------------------------
2-67 Name: John W. Holtermann x
2-68 Representing: TX Silver Haired Legislature
2-69 City: San Marcos
2-70 -------------------------------------------------------------------
3-1 Name: Phill Parmer x
3-2 Representing: TX Silver Haired Legislature
3-3 City: Sunrise Beach, TX
3-4 -------------------------------------------------------------------