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. _______________________________ _______________________________ President of the Senate Speaker of the House I certify that H.B. No. 839 was passed by the House on May 5, 1997, by a non-record vote. _______________________________ Chief Clerk of the House I certify that H.B. No. 839 was passed by the Senate on May 26, 1997, by the following vote: Yeas 31, Nays 0. _______________________________ Secretary of the Senate APPROVED: _____________________ Date _____________________ Governor