By Driver, Averitt, Davila, Burnam, Danburg H.B. No. 839
75R10644 SAW-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to prohibiting discrimination by insurers in issuing
1-3 health or life insurance policies to certain persons who are
1-4 victims of family violence.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter B, Chapter 21, Insurance Code, is
1-7 amended by adding Article 21.21-5 to read as follows:
1-8 Art. 21.21-5. VICTIMS OF FAMILY VIOLENCE
1-9 Sec. 1. DEFINITION. In this article, "family violence"
1-10 means the occurrence of one or more of the following acts between
1-11 persons who reside together or who formerly resided together:
1-12 (1) wilfully attempting to cause bodily injury, or
1-13 wilfully or wantonly causing bodily injury;
1-14 (2) wilfully placing another, by physical threat, in
1-15 fear of imminent bodily injury; or
1-16 (3) engaging in any of the following acts with a minor
1-17 under 16 years of age who is not the spouse of the person engaging
1-18 in the act:
1-19 (A) the act of sexual intercourse; or
1-20 (B) any lewd fondling or touching of the person
1-21 of either the minor or the other person, done or submitted to with
1-22 the intent to arouse or to satisfy the sexual desires of either the
1-23 minor or the other person or both.
1-24 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only
2-1 to:
2-2 (1) a life insurer that delivers, issues for delivery,
2-3 or renews a life insurance contract or policy in this state,
2-4 including any group contract, policy, or certificate of life
2-5 insurance; and
2-6 (2) a health benefit plan issuer that provides
2-7 benefits for medical or surgical expenses incurred as a result of a
2-8 health condition, accident, or sickness, including:
2-9 (A) an insurance company;
2-10 (B) a group hospital service corporation
2-11 operating under Chapter 20 of this code;
2-12 (C) a fraternal benefit society operating under
2-13 Chapter 10 of this code;
2-14 (D) a stipulated premium insurance company
2-15 operating under Chapter 22 of this code;
2-16 (E) a health carrier under Chapter 26 of this
2-17 code;
2-18 (F) a health maintenance organization operating
2-19 under the Texas Health Maintenance Organization Act (Chapter 20A,
2-20 Vernon's Texas Insurance Code);
2-21 (G) an employer under a multiple employer
2-22 welfare arrangement as defined by Section 3, Employee Retirement
2-23 Income Security Act of 1974 (29 U.S.C. Section 1002), or other
2-24 analogous benefit arrangement, to the extent permitted by the
2-25 Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
2-26 1001 et seq.);
2-27 (H) an issuer of a Medicare supplemental policy
3-1 as defined by Section 1882(g)(1), Social Security Act (42 U.S.C.
3-2 Section 1395ss); or
3-3 (I) an approved nonprofit health corporation
3-4 that is certified under Section 5.01(a), Medical Practice Act
3-5 (Article 4495b, Vernon's Texas Civil Statutes), and that holds a
3-6 certificate of authority issued by the commissioner under Article
3-7 21.52F of this code.
3-8 (b) This article does not apply to the issuer of:
3-9 (1) a health benefit plan that provides coverage:
3-10 (A) only for a specified disease;
3-11 (B) only for accidental death or dismemberment;
3-12 (C) for wages or payments in lieu of wages for a
3-13 period during which an employee is absent from work because of
3-14 sickness or injury;
3-15 (D) as a supplement to liability insurance;
3-16 (E) only for limited benefits; or
3-17 (F) only for dental or vision care;
3-18 (2) hospital confinement indemnity coverage;
3-19 (3) a credit insurance policy;
3-20 (4) workers' compensation insurance coverage;
3-21 (5) medical payment insurance issued as part of a
3-22 motor vehicle insurance policy; or
3-23 (6) a long-term care policy, including a nursing home
3-24 fixed indemnity policy, unless the commissioner determines that the
3-25 policy provides benefit coverage so comprehensive that the policy
3-26 is a health benefit plan as described by Subsection (a) of this
3-27 section.
4-1 Sec. 3. PROHIBITIONS. (a) A health benefit plan issuer or
4-2 life insurer, because of an individual's status as a victim of
4-3 family violence, may not:
4-4 (1) deny coverage to the individual;
4-5 (2) refuse to renew the individual's coverage;
4-6 (3) cancel the individual's coverage;
4-7 (4) limit the amount, extent, or kind of coverage
4-8 available to the individual; or
4-9 (5) charge the individual or a group to which the
4-10 individual belongs a different rate for the same coverage.
4-11 (b) A health benefit plan issuer or life insurer may not, as
4-12 a part of an application for coverage, require an applicant to
4-13 reveal whether the applicant has been or may become a victim of
4-14 family violence.
4-15 Sec. 4. SANCTIONS. A health benefit plan issuer or life
4-16 insurer who violates this article commits an unfair and deceptive
4-17 practice as defined by Article 21.21 of this code and is subject to
4-18 the penalties imposed under that article.
4-19 Sec. 5. RELEASE FROM LIABILITY. A health benefit plan
4-20 provider or life insurer who delivers, issues for delivery, or
4-21 renews a health benefit plan or a life insurance policy or contract
4-22 for an individual who has been or may become a victim of family
4-23 violence may not be held civilly or criminally liable for the death
4-24 of, or bodily injuries incurred by, that individual as a result of
4-25 family violence.
4-26 Sec. 6. UNDERWRITING CRITERIA. Notwithstanding any other
4-27 provision of this article, a health benefit plan issuer or life
5-1 insurer may underwrite a risk on the basis of an individual's
5-2 physical or mental condition regardless of the underlying cause of
5-3 the condition, or on the basis of any underwriting criteria not
5-4 prohibited by this code, another insurance law of this state, or a
5-5 rule adopted under this code or another insurance law of this
5-6 state, provided that the health benefit plan issuer or life insurer
5-7 consistently applies the criteria and does not merely use the
5-8 criteria as a pretext to evade application of Section 3 of this
5-9 article.
5-10 Sec. 7. CONTINUED COVERAGE. This article does not affect
5-11 the right of an individual to continued coverage under Section 3B,
5-12 Article 3.51-6, Insurance Code.
5-13 Sec. 8. CONFIDENTIALITY. (a) Except as provided by
5-14 Subsection (b) of this section, a health benefit plan issuer, life
5-15 insurer, or person employed by or under contract with a health
5-16 benefit plan issuer or life insurer may not release information
5-17 relating to the status as a victim of family violence of an
5-18 individual who is clearly a victim of family violence, including:
5-19 (1) information about specific acts of family violence
5-20 directed at the individual;
5-21 (2) the individual's address or phone number at home
5-22 or at work; and
5-23 (3) information about the individual's employment,
5-24 associations, family membership, or relationships.
5-25 (b) A health benefit plan issuer or life insurer may only
5-26 release information relating to the status as a victim of family
5-27 violence of an individual who is clearly a victim of family
6-1 violence:
6-2 (1) to the victim or another individual designated in
6-3 writing by the victim;
6-4 (2) to a physician or health care provider for the
6-5 provision of health care services;
6-6 (3) to a licensed physician designated by the victim;
6-7 (4) as required by other law or an order of the
6-8 commissioner or a court of competent jurisdiction;
6-9 (5) when necessary for a valid business purpose if:
6-10 (A) the information cannot be segregated from
6-11 other information about the victim without undue hardship to the
6-12 health benefit plan issuer or life insurer;
6-13 (B) the recipient of the information agrees in
6-14 writing to be subject to the requirements of this article; and
6-15 (C) the recipient of the information is:
6-16 (i) a reinsurer that seeks to indemnify or
6-17 indemnifies all or any part of a health benefit plan or life
6-18 insurance contract or policy covering the victim of family violence
6-19 when the reinsurer cannot underwrite or satisfy obligations under
6-20 the reinsurance agreement without release of the information;
6-21 (ii) a party to a proposed or consummated
6-22 sale, transfer, merger, or consolidation of all or part of the
6-23 business of the health benefit plan provider or life insurer;
6-24 (iii) medical or claims personnel under
6-25 contract with the health benefit plan provider or life insurer,
6-26 including parent or affiliate companies under service agreements
6-27 with the health benefit plan provider or life insurer, when release
7-1 of the information is necessary to process an application, to
7-2 perform duties under the health benefit plan or life insurance
7-3 contract or policy, or to protect the safety or privacy of a victim
7-4 of family violence; or
7-5 (iv) an entity with which the health
7-6 benefit plan provider transacts business when the information is
7-7 only the address or telephone number of the victim and the entity
7-8 cannot transact the business without the address or telephone
7-9 number;
7-10 (6) to an attorney who needs the information to
7-11 represent effectively the health benefit plan issuer or the life
7-12 insurer, if the health benefit plan issuer or life insurer notifies
7-13 the attorney of requirements of this article and requests that the
7-14 attorney exercise due diligence to protect the information
7-15 consistent with the attorney's obligation to represent the health
7-16 benefit plan issuer or life insurer;
7-17 (7) to the individual covered under or owner of the
7-18 health benefit plan or life insurance contract or policy, if the
7-19 plan, contract, or policy contains information about status as a
7-20 victim of family violence; or
7-21 (8) to any other individual or entity deemed
7-22 appropriate by the commissioner.
7-23 SECTION 2. Section 14(b), Texas Health Maintenance
7-24 Organization Act (Article 20A.14, Vernon's Texas Insurance Code),
7-25 is amended to read as follows:
7-26 (b) Articles 21.21, 21.21A, 21.21-2, 21.21-3, and 21.21-5,
7-27 Insurance Code, Article 21.21-6, Insurance Code, as added by
8-1 Chapter 522, Acts of the 74th Legislature, Regular Session, 1995,
8-2 and Chapter 122, Acts of the 57th Legislature, Regular Session,
8-3 1961 (Article 21.21-1, Vernon's Texas Insurance Code), apply to
8-4 health maintenance organizations that offer both basic and single
8-5 health care coverages and to basic and single health care plans and
8-6 the evidence of coverage under those plans, except to the extent
8-7 that the commissioner determines that the nature of health
8-8 maintenance organizations and health care plans and evidence of
8-9 coverage renders any provision of those articles clearly
8-10 inappropriate.
8-11 SECTION 3. This Act takes effect September 1, 1997, and
8-12 applies only to an insurance policy or contract or an evidence of
8-13 coverage that is delivered, issued for delivery, or renewed on or
8-14 after January 1, 1998. A policy or contract or an evidence of
8-15 coverage that is delivered, issued for delivery, or renewed before
8-16 January 1, 1998, is governed by the law as it existed immediately
8-17 before the effective date of this Act, and that law is continued in
8-18 effect for that purpose.
8-19 SECTION 4. The importance of this legislation and the
8-20 crowded condition of the calendars in both houses create an
8-21 emergency and an imperative public necessity that the
8-22 constitutional rule requiring bills to be read on three several
8-23 days in each house be suspended, and this rule is hereby suspended.