By Janek                                         H.B. No. 612

      75R583 MWV-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to certain disclosures to be made by a health benefit plan

 1-3     business.

 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 21.62 to read as follows:

 1-7           Art. 21.62.  HEALTH BENEFIT PLAN DISCLOSURE.  (a)  In this

 1-8     article:

 1-9                 (1)  "Health benefit plan" means a plan that provides

1-10     benefits for medical or surgical expenses incurred as a result of a

1-11     health condition, accident, or sickness and that is offered by any

1-12     insurance company, group hospital service corporation, or health

1-13     maintenance organization that delivers or issues for delivery an

1-14     individual, group, blanket, or franchise insurance policy or

1-15     insurance agreement, a group hospital service contract, or an

1-16     evidence of coverage, by a multiple employer welfare arrangement as

1-17     defined by Section 3, Employee Retirement Income Security Act of

1-18     1974 (29 U.S.C. Section 1002), or by any other analogous benefit

1-19     arrangement to the extent permitted by the Employee Retirement

1-20     Income Security Act of 1974 (29 U.S.C. Section 1002).  The term

1-21     does not include:

1-22                       (A)  a plan that provides coverage:

1-23                             (i)  only for accidental death or

1-24     dismemberment;

 2-1                             (ii)  for wages or payments in lieu of

 2-2     wages for a period during which an employee is absent from work

 2-3     because of sickness or injury; or

 2-4                             (iii)  as a supplement to liability

 2-5     insurance;

 2-6                       (B)  a medicare supplemental policy as defined by

 2-7     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);

 2-8                       (C)  worker's compensation insurance coverage;

 2-9                       (D)  medical payment insurance issued as part of

2-10     a motor vehicle insurance policy; or

2-11                       (E)  a long-term care policy, including a nursing

2-12     home fixed indemnity policy, unless the commissioner determines

2-13     that the policy provides benefit coverage so comprehensive that the

2-14     policy meets the definition of a health benefit plan.

2-15                 (2)  "Health benefit plan business" means an

2-16     individual, corporation, association, partnership, or any other

2-17     entity engaged in the business of selling or providing a health

2-18     benefit plan, including an insurance agent or broker.

2-19           (b)  A health benefit plan business shall, at the time of

2-20     making an offer to provide a health benefit plan, disclose the

2-21     ratio of coverage premiums paid by consumers to the estimated

2-22     benefits paid to consumers during the previous calendar year under

2-23     the health benefit plan offered.

2-24           (c)  The commissioner shall adopt rules to:

2-25                 (1)  establish fair standards of disclosure as required

2-26     by this article; and

2-27                 (2)  administer this article.

 3-1           SECTION 2.  This Act takes effect September 1, 1997, and

 3-2     applies only to an offer to provide a health benefit plan made on

 3-3     or after January 1, 1998.  An offer to provide a health benefit

 3-4     plan that is made before January 1, 1998, is governed by the law as

 3-5     it existed immediately before the effective date of this Act, and

 3-6     that law is continued in effect for that purpose.

 3-7           SECTION 3.  The importance of this legislation and the

 3-8     crowded condition of the calendars in both houses create an

 3-9     emergency and an imperative public necessity that the

3-10     constitutional rule requiring bills to be read on three several

3-11     days in each house be suspended, and this rule is hereby suspended.