75R6580 PB-F
By Van de Putte, Gray, Hochberg H.B. No. 263
Substitute the following for H.B. No. 263:
By Lewis of Tarrant C.S.H.B. No. 263
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to restrictions on the use of certain genetic information
1-3 by insurers.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.73 to read as follows:
1-7 Art. 21.73. USE OF GENETIC TESTING INFORMATION BY INSURERS
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "DNA" means deoxyribonucleic acid.
1-10 (2) "Genetic information" means information derived
1-11 from a genetic test.
1-12 (3) "Genetic test" means a laboratory test of an
1-13 individual's DNA, RNA, or chromosomes to identify by analysis of
1-14 the DNA, RNA, or chromosomes the genetic mutations or alterations
1-15 in the DNA, RNA, or chromosomes that are associated with a
1-16 predisposition for a clinically recognized disease or disorder. The
1-17 term does not include:
1-18 (A) a routine physical examination or a routine
1-19 test performed as a part of a physical examination;
1-20 (B) a chemical, blood, or urine analysis;
1-21 (C) a test to determine drug use; or
1-22 (D) a test for the presence of the human
1-23 immunodeficiency virus.
1-24 (4) "Health benefit plan" means a plan described by
2-1 Section 2 of this article.
2-2 (5) "RNA" means ribonucleic acid.
2-3 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to a
2-4 health benefit plan that:
2-5 (1) provides benefits for medical or surgical expenses
2-6 incurred as a result of a health condition, accident, or sickness,
2-7 including:
2-8 (A) an individual, group, blanket, or franchise
2-9 insurance policy or insurance agreement, a group hospital service
2-10 contract, or an individual or group evidence of coverage that is
2-11 offered by:
2-12 (i) an insurance company;
2-13 (ii) a group hospital service corporation
2-14 operating under Chapter 20 of this code;
2-15 (iii) a fraternal benefit society
2-16 operating under Chapter 10 of this code;
2-17 (iv) a stipulated premium insurance
2-18 company operating under Chapter 22 of this code; or
2-19 (v) a health maintenance organization
2-20 operating under the Texas Health Maintenance Organization Act
2-21 (Chapter 20A, Vernon's Texas Insurance Code); or
2-22 (B) to the extent permitted by the Employee
2-23 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-24 seq.), a health benefit plan that is offered by:
2-25 (i) a multiple employer welfare
2-26 arrangement as defined by Section 3, Employee Retirement Income
2-27 Security Act of 1974 (29 U.S.C. Section 1002); or
3-1 (ii) another analogous benefit
3-2 arrangement;
3-3 (2) is offered by an approved nonprofit health
3-4 corporation that is certified under Section 5.01(a), Medical
3-5 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
3-6 that holds a certificate of authority issued by the commissioner
3-7 under Article 21.52F of this code; or
3-8 (3) is offered by any other entity not licensed under
3-9 this code or another insurance law of this state that contracts
3-10 directly for health care services on a risk-sharing basis,
3-11 including an entity that contracts for health care services on a
3-12 capitation basis.
3-13 (b) This article does not apply to:
3-14 (1) a plan that provides coverage:
3-15 (A) only for a specified disease;
3-16 (B) only for accidental death or dismemberment;
3-17 (C) for wages or payments in lieu of wages for a
3-18 period during which an employee is absent from work because of
3-19 sickness or injury; or
3-20 (D) as a supplement to liability insurance;
3-21 (2) a plan written under Chapter 26 of this code;
3-22 (3) a Medicare supplemental policy as defined by
3-23 Section 1882(g)(1), Social Security Act (42 U.S.C. 1395ss);
3-24 (4) workers' compensation insurance coverage;
3-25 (5) medical payment insurance issued as part of a
3-26 motor vehicle insurance policy; or
3-27 (6) a long-term care policy, including a nursing home
4-1 fixed indemnity policy, unless the commissioner determines that the
4-2 policy provides benefit coverage so comprehensive that the policy
4-3 is a health benefit plan as described by Subsection (a) of this
4-4 section.
4-5 Sec. 3. USE OF GENETIC INFORMATION. (a) A health benefit
4-6 plan issuer may not:
4-7 (1) use genetic information or a genetic test to
4-8 reject, deny, limit, cancel, refuse to renew, or otherwise
4-9 adversely affect eligibility for or coverage under a health benefit
4-10 plan; or
4-11 (2) require an individual who is a covered person or
4-12 insured under the health benefit plan or an applicant for coverage
4-13 under the plan to disclose to the health benefit plan issuer
4-14 genetic information regarding that individual or a member of that
4-15 individual's family.
4-16 (b) If a health benefit plan issuer requests that an
4-17 applicant for coverage under the health benefit plan submit to a
4-18 genetic test in connection with the application for coverage, the
4-19 health benefit plan issuer shall first obtain the applicant's
4-20 written informed consent. The consent must include:
4-21 (1) a description of the particular test or tests to
4-22 be performed;
4-23 (2) a general statement regarding the significance of
4-24 each test with respect to the coverage for which the applicant is
4-25 applying;
4-26 (3) a statement informing the individual that specific
4-27 confidentiality restrictions apply to the results of the genetic
5-1 test; and
5-2 (4) a statement that the individual has a right to
5-3 know the results of each test and that, on the written request of
5-4 the individual, the health benefit plan issuer shall disclose the
5-5 results of each test to the individual or to a physician designated
5-6 by the individual.
5-7 (c) A health benefit plan issuer may not use the results of
5-8 a genetic test conducted in accordance with Subsection (b) of this
5-9 section as an inducement for the purchase of coverage under the
5-10 plan.
5-11 Sec. 4. INFORMATION CONFIDENTIAL; EXCEPTIONS. (a) Except
5-12 as provided by Subsections (c) and (d) of this section, a person
5-13 or entity who holds genetic information about an individual may not
5-14 disclose or be compelled to disclose that information, by subpoena
5-15 or otherwise, unless the disclosure is authorized by the individual
5-16 as provided by Subsection (b) of this section.
5-17 (b) An individual or the legal representative of an
5-18 individual may authorize the disclosure of genetic information
5-19 relating to that individual through an authorization that:
5-20 (1) is written in plain language;
5-21 (2) is dated;
5-22 (3) contains a specific description of the information
5-23 to be disclosed;
5-24 (4) identifies or describes each person authorized to
5-25 disclose the genetic information to a health benefit plan issuer;
5-26 (5) identifies or describes the individuals or
5-27 entities to whom the disclosure or subsequent redisclosure of the
6-1 genetic information may be made;
6-2 (6) describes the specific purpose of the disclosure;
6-3 (7) is signed by the individual or the legal
6-4 representative and if the disclosure is for claiming proceeds of
6-5 any affected life insurance policy, the claimant; and
6-6 (8) advises the individual or legal representative
6-7 that the individual's authorized representative is entitled to
6-8 receive a copy of the authorization form.
6-9 (c) Subject to Subchapter G, Chapter 411, Government Code,
6-10 genetic information relating to an individual may be disclosed
6-11 without the authorization required under Subsection (b) of this
6-12 section if the disclosure is:
6-13 (1) authorized under a state or federal criminal law
6-14 relating to:
6-15 (A) the identification of an individual; or
6-16 (B) a criminal or juvenile proceeding, an
6-17 inquest, or a child fatality review by a multidisciplinary child
6-18 abuse team;
6-19 (2) required under a specific order of a state or
6-20 federal court;
6-21 (3) authorized under a state or federal law to
6-22 establish paternity;
6-23 (4) made to furnish genetic information about a
6-24 decedent to a person related to the decedent by consanguinity for
6-25 the purpose of the person's medical diagnosis; or
6-26 (5) to identify a decedent.
6-27 (d) Except as provided by this subsection, a health benefit
7-1 plan issuer may not redisclose genetic information unless the
7-2 redisclosure is consistent with the disclosures authorized by the
7-3 tested individual under an authorization form executed under
7-4 Subsection (b) of this section. A health benefit plan issuer may
7-5 redisclose genetic information:
7-6 (1) for actuarial or research studies, if:
7-7 (A) a tested individual may not be identified in
7-8 any actuarial or research report; and
7-9 (B) any materials that identify a tested
7-10 individual are returned or destroyed as soon as reasonably
7-11 practicable;
7-12 (2) to the department for the purposes of the
7-13 enforcement of this article; or
7-14 (3) for purposes directly related to enabling business
7-15 decisions to be made about the purchase, transfer, merger, or sale
7-16 of all or part of an insurance business or about obtaining
7-17 reinsurance affecting that insurance business.
7-18 (e) A redisclosure authorized under Subsection (d) of this
7-19 section may contain only information reasonably necessary to
7-20 accomplish the purpose for which the information is disclosed.
7-21 Sec. 5. RULES. The commissioner shall adopt rules as
7-22 necessary to implement and enforce this article.
7-23 Sec. 6. PENALTIES. The commissioner, on finding that a
7-24 health benefit plan issuer is violating this article, may issue a
7-25 cease and desist order to the health benefit plan issuer. If the
7-26 health benefit plan issuer refuses or fails to comply with that
7-27 order, the commissioner may:
8-1 (1) revoke or suspend the certificate of authority or
8-2 other credential of the health benefit plan issuer as provided by
8-3 this code or another insurance law of this state; and
8-4 (2) impose administrative penalties under Article
8-5 1.10E of this code.
8-6 SECTION 2. Article 21.73, Insurance Code, as added by this
8-7 Act, applies only to a health benefit plan delivered, issued for
8-8 delivery, or renewed on or after January 1, 1998. A plan
8-9 delivered, issued for delivery, or renewed before January 1, 1998,
8-10 is governed by the law as it existed immediately before the
8-11 effective date of this Act, and that law is continued in effect for
8-12 that purpose.
8-13 SECTION 3. This Act takes effect September 1, 1997.
8-14 SECTION 4. The importance of this legislation and the
8-15 crowded condition of the calendars in both houses create an
8-16 emergency and an imperative public necessity that the
8-17 constitutional rule requiring bills to be read on three several
8-18 days in each house be suspended, and this rule is hereby suspended.