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.