1-1 By: Driver, et al. (Senate Sponsor - Cain) H.B. No. 839 1-2 (In the Senate - Received from the House May 6, 1997; 1-3 May 7, 1997, read first time and referred to Committee on Economic 1-4 Development; May 16, 1997, reported favorably by the following 1-5 vote: Yeas 8, Nays 0; May 16, 1997, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to prohibiting discrimination by insurers in issuing 1-9 health or life insurance policies to certain persons who are 1-10 victims of family violence. 1-11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-12 SECTION 1. Subchapter B, Chapter 21, Insurance Code, is 1-13 amended by adding Article 21.21-5 to read as follows: 1-14 Art. 21.21-5. VICTIMS OF FAMILY VIOLENCE 1-15 Sec. 1. DEFINITION. In this article, "family violence" 1-16 means the occurrence of one or more of the following acts between 1-17 persons who reside together or who formerly resided together: 1-18 (1) wilfully attempting to cause bodily injury, or 1-19 wilfully or wantonly causing bodily injury; 1-20 (2) wilfully placing another, by physical threat, in 1-21 fear of imminent bodily injury; or 1-22 (3) engaging in any of the following acts with a minor 1-23 under 16 years of age who is not the spouse of the person engaging 1-24 in the act: 1-25 (A) the act of sexual intercourse; or 1-26 (B) any lewd fondling or touching of the person 1-27 of either the minor or the other person, done or submitted to with 1-28 the intent to arouse or to satisfy the sexual desires of either the 1-29 minor or the other person or both. 1-30 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only 1-31 to: 1-32 (1) a life insurer that delivers, issues for delivery, 1-33 or renews a life insurance contract or policy in this state, 1-34 including any group contract, policy, or certificate of life 1-35 insurance; and 1-36 (2) a health benefit plan issuer that provides 1-37 benefits for medical or surgical expenses incurred as a result of a 1-38 health condition, accident, or sickness, including: 1-39 (A) an insurance company; 1-40 (B) a group hospital service corporation 1-41 operating under Chapter 20 of this code; 1-42 (C) a fraternal benefit society operating under 1-43 Chapter 10 of this code; 1-44 (D) a stipulated premium insurance company 1-45 operating under Chapter 22 of this code; 1-46 (E) a health carrier under Chapter 26 of this 1-47 code; 1-48 (F) a health maintenance organization operating 1-49 under the Texas Health Maintenance Organization Act (Chapter 20A, 1-50 Vernon's Texas Insurance Code); 1-51 (G) an employer under a multiple employer 1-52 welfare arrangement as defined by Section 3, Employee Retirement 1-53 Income Security Act of 1974 (29 U.S.C. Section 1002), or other 1-54 analogous benefit arrangement, to the extent permitted by the 1-55 Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1-56 1001 et seq.); 1-57 (H) an issuer of a Medicare supplemental policy 1-58 as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. 1-59 Section 1395ss); or 1-60 (I) an approved nonprofit health corporation 1-61 that is certified under Section 5.01(a), Medical Practice Act 1-62 (Article 4495b, Vernon's Texas Civil Statutes), and that holds a 1-63 certificate of authority issued by the commissioner under Article 1-64 21.52F of this code. 2-1 (b) This article does not apply to the issuer of: 2-2 (1) a health benefit plan that provides coverage: 2-3 (A) only for a specified disease; 2-4 (B) only for accidental death or dismemberment; 2-5 (C) for wages or payments in lieu of wages for a 2-6 period during which an employee is absent from work because of 2-7 sickness or injury; 2-8 (D) as a supplement to liability insurance; 2-9 (E) only for limited benefits; or 2-10 (F) only for dental or vision care; 2-11 (2) hospital confinement indemnity coverage; 2-12 (3) a credit insurance policy; 2-13 (4) workers' compensation insurance coverage; 2-14 (5) medical payment insurance issued as part of a 2-15 motor vehicle insurance policy; or 2-16 (6) a long-term care policy, including a nursing home 2-17 fixed indemnity policy, unless the commissioner determines that the 2-18 policy provides benefit coverage so comprehensive that the policy 2-19 is a health benefit plan as described by Subsection (a) of this 2-20 section. 2-21 Sec. 3. PROHIBITIONS. (a) A health benefit plan issuer or 2-22 life insurer, because of an individual's status as a victim of 2-23 family violence, may not: 2-24 (1) deny coverage to the individual; 2-25 (2) refuse to renew the individual's coverage; 2-26 (3) cancel the individual's coverage; 2-27 (4) limit the amount, extent, or kind of coverage 2-28 available to the individual; or 2-29 (5) charge the individual or a group to which the 2-30 individual belongs a different rate for the same coverage. 2-31 (b) A health benefit plan issuer or life insurer may not, as 2-32 a part of an application for coverage, require an applicant to 2-33 reveal whether the applicant has been or may become a victim of 2-34 family violence. 2-35 Sec. 4. SANCTIONS. A health benefit plan issuer or life 2-36 insurer who violates this article commits an unfair and deceptive 2-37 practice as defined by Article 21.21 of this code and is subject to 2-38 the penalties imposed under that article. 2-39 Sec. 5. RELEASE FROM LIABILITY. A health benefit plan 2-40 provider or life insurer who delivers, issues for delivery, or 2-41 renews a health benefit plan or a life insurance policy or contract 2-42 for an individual who has been or may become a victim of family 2-43 violence may not be held civilly or criminally liable for the death 2-44 of, or bodily injuries incurred by, that individual as a result of 2-45 family violence. 2-46 Sec. 6. UNDERWRITING CRITERIA. Notwithstanding any other 2-47 provision of this article, a health benefit plan issuer or life 2-48 insurer may underwrite a risk on the basis of an individual's 2-49 physical or mental condition regardless of the underlying cause of 2-50 the condition, or on the basis of any underwriting criteria not 2-51 prohibited by this code, another insurance law of this state, or a 2-52 rule adopted under this code or another insurance law of this 2-53 state, provided that the health benefit plan issuer or life insurer 2-54 consistently applies the criteria and does not merely use the 2-55 criteria as a pretext to evade application of Section 3 of this 2-56 article. 2-57 Sec. 7. CONTINUED COVERAGE. This article does not affect 2-58 the right of an individual to continued coverage under Section 3B, 2-59 Article 3.51-6, Insurance Code. 2-60 Sec. 8. CONFIDENTIALITY. (a) Except as provided by 2-61 Subsection (b) of this section, a health benefit plan issuer, life 2-62 insurer, or person employed by or under contract with a health 2-63 benefit plan issuer or life insurer may not release information 2-64 relating to the status as a victim of family violence of an 2-65 individual who is clearly a victim of family violence, including: 2-66 (1) information about specific acts of family violence 2-67 directed at the individual; 2-68 (2) the individual's address or phone number at home 2-69 or at work; and 3-1 (3) information about the individual's employment, 3-2 associations, family membership, or relationships. 3-3 (b) A health benefit plan issuer or life insurer may only 3-4 release information relating to the status as a victim of family 3-5 violence of an individual who is clearly a victim of family 3-6 violence: 3-7 (1) to the victim or another individual designated in 3-8 writing by the victim; 3-9 (2) to a physician or health care provider for the 3-10 provision of health care services; 3-11 (3) to a licensed physician designated by the victim; 3-12 (4) as required by other law or an order of the 3-13 commissioner or a court of competent jurisdiction; 3-14 (5) when necessary for a valid business purpose if: 3-15 (A) the information cannot be segregated from 3-16 other information about the victim without undue hardship to the 3-17 health benefit plan issuer or life insurer; 3-18 (B) the recipient of the information agrees in 3-19 writing to be subject to the requirements of this article; and 3-20 (C) the recipient of the information is: 3-21 (i) a reinsurer that seeks to indemnify or 3-22 indemnifies all or any part of a health benefit plan or life 3-23 insurance contract or policy covering the victim of family violence 3-24 when the reinsurer cannot underwrite or satisfy obligations under 3-25 the reinsurance agreement without release of the information; 3-26 (ii) a party to a proposed or consummated 3-27 sale, transfer, merger, or consolidation of all or part of the 3-28 business of the health benefit plan provider or life insurer; 3-29 (iii) medical or claims personnel under 3-30 contract with the health benefit plan provider or life insurer, 3-31 including parent or affiliate companies under service agreements 3-32 with the health benefit plan provider or life insurer, when release 3-33 of the information is necessary to process an application, to 3-34 perform duties under the health benefit plan or life insurance 3-35 contract or policy, or to protect the safety or privacy of a victim 3-36 of family violence; or 3-37 (iv) an entity with which the health 3-38 benefit plan provider transacts business when the information is 3-39 only the address or telephone number of the victim and the entity 3-40 cannot transact the business without the address or telephone 3-41 number; 3-42 (6) to an attorney who needs the information to 3-43 represent effectively the health benefit plan issuer or the life 3-44 insurer, if the health benefit plan issuer or life insurer notifies 3-45 the attorney of requirements of this article and requests that the 3-46 attorney exercise due diligence to protect the information 3-47 consistent with the attorney's obligation to represent the health 3-48 benefit plan issuer or life insurer; 3-49 (7) to the individual covered under or owner of the 3-50 health benefit plan or life insurance contract or policy, if the 3-51 plan, contract, or policy contains information about status as a 3-52 victim of family violence; or 3-53 (8) to any other individual or entity deemed 3-54 appropriate by the commissioner. 3-55 SECTION 2. Section 14(b), Texas Health Maintenance 3-56 Organization Act (Article 20A.14, Vernon's Texas Insurance Code), 3-57 is amended to read as follows: 3-58 (b) Articles 21.21, 21.21A, 21.21-2, 21.21-3, and 21.21-5, 3-59 Insurance Code, Article 21.21-6, Insurance Code, as added by 3-60 Chapter 522, Acts of the 74th Legislature, Regular Session, 1995, 3-61 and Chapter 122, Acts of the 57th Legislature, Regular Session, 3-62 1961 (Article 21.21-1, Vernon's Texas Insurance Code), apply to 3-63 health maintenance organizations that offer both basic and single 3-64 health care coverages and to basic and single health care plans and 3-65 the evidence of coverage under those plans, except to the extent 3-66 that the commissioner determines that the nature of health 3-67 maintenance organizations and health care plans and evidence of 3-68 coverage renders any provision of those articles clearly 3-69 inappropriate. 4-1 SECTION 3. This Act takes effect September 1, 1997, and 4-2 applies only to an insurance policy or contract or an evidence of 4-3 coverage that is delivered, issued for delivery, or renewed on or 4-4 after January 1, 1998. A policy or contract or an evidence of 4-5 coverage that is delivered, issued for delivery, or renewed before 4-6 January 1, 1998, is governed by the law as it existed immediately 4-7 before the effective date of this Act, and that law is continued in 4-8 effect for that purpose. 4-9 SECTION 4. The importance of this legislation and the 4-10 crowded condition of the calendars in both houses create an 4-11 emergency and an imperative public necessity that the 4-12 constitutional rule requiring bills to be read on three several 4-13 days in each house be suspended, and this rule is hereby suspended. 4-14 * * * * *