By Burnam                                       H.B. No. 1675

      75R6707 SAW-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to discrimination against certain victims of family

 1-3     violence by health benefit plan providers.


 1-5           SECTION 1.  Subchapter B, Chapter 21, Insurance Code, is

 1-6     amended by adding Article 21.21-5 to read as follows:

 1-7           Art. 21.21-5.  VICTIMS OF FAMILY VIOLENCE

 1-8           Sec. 1.  DEFINITIONS.  In this article:

 1-9                 (1)  "Family violence" has the meaning assigned by

1-10     Section 71.01(b), Family Code.

1-11                 (2)  "Health benefit plan" means a plan described by

1-12     Section 2 of this article.

1-13           Sec. 2.  SCOPE OF ARTICLE.  (a)  This article applies only to

1-14     a health benefit plan that:

1-15                 (1)  provides benefits for medical or surgical expenses

1-16     incurred as a result of a health condition, accident, or sickness,

1-17     including:

1-18                       (A)  an individual, group, blanket, or franchise

1-19     insurance policy or insurance agreement, a group hospital service

1-20     contract, or an individual or group evidence of coverage that is

1-21     offered by:

1-22                             (i)  an insurance company;

1-23                             (ii)  a group hospital service corporation

1-24     operating under Chapter 20 of this code;

 2-1                             (iii)  a fraternal benefit society

 2-2     operating under Chapter 10 of this code;

 2-3                             (iv)  a stipulated premium insurance

 2-4     company operating under Chapter 22 of this code;

 2-5                             (v)  a health carrier under Chapter 26 of

 2-6     this code; or

 2-7                             (vi)  a health maintenance organization

 2-8     operating under the Texas Health Maintenance Organization Act

 2-9     (Chapter 20A, Vernon's Texas Insurance Code);

2-10                       (B)  to the extent permitted by the Employee

2-11     Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et

2-12     seq.), a health benefit plan that is offered by:

2-13                             (i)  a multiple employer welfare

2-14     arrangement as defined by Section 3, Employee Retirement Income

2-15     Security Act of 1974 (29 U.S.C. Section 1002); or

2-16                             (ii)  another analogous benefit

2-17     arrangement; or

2-18                       (C)  a Medicare supplemental policy as defined by

2-19     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);

2-20                 (2)  is offered by an approved nonprofit health

2-21     corporation that is certified under Section 5.01(a), Medical

2-22     Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and

2-23     that holds a certificate of authority issued by the commissioner

2-24     under Article 21.52F of this code; or

2-25                 (3)  is offered by any other entity not licensed under

2-26     this code or another insurance law of this state that contracts

2-27     directly for health care services on a risk-sharing basis,

 3-1     including an entity that contracts for health care services on a

 3-2     capitation basis.

 3-3           (b)  This article does not apply to:

 3-4                 (1)  a plan that provides coverage:

 3-5                       (A)  only for a specified disease;

 3-6                       (B)  only for accidental death or dismemberment;

 3-7                       (C)  for wages or payments in lieu of wages for a

 3-8     period during which an employee is absent from work because of

 3-9     sickness or injury; or

3-10                       (D)  as a supplement to liability insurance;

3-11                 (2)  workers' compensation insurance coverage;

3-12                 (3)  medical payment insurance issued as part of a

3-13     motor vehicle insurance policy; or

3-14                 (4)  a long-term care policy, including a nursing home

3-15     fixed indemnity policy, unless the commissioner determines that the

3-16     policy provides benefit coverage so comprehensive that the policy

3-17     is a health benefit plan as described by Subsection (a) of this

3-18     section.

3-19           Sec. 3.  PROHIBITIONS.  (a)  A health benefit plan issuer may

3-20     not, as part of an application for coverage, require an individual

3-21     to reveal whether the individual is, has been, or may be a victim

3-22     of family violence.

3-23           (b)  A health benefit plan issuer, solely because an

3-24     individual is, has been, or may be a victim of family violence, may

3-25     not:

3-26                 (1)  refuse to accept from the individual an

3-27     application for a health benefit plan;

 4-1                 (2)  refuse to issue, deny, refuse to renew, or cancel

 4-2     a health benefit plan;

 4-3                 (3)  limit the amount, extent, or kind of coverage

 4-4     available to the individual through a health benefit plan; or

 4-5                 (4)  charge the individual or a group to which the

 4-6     individual belongs a higher rate for the same health benefit plan

 4-7     coverage.

 4-8           (c)  A health benefit plan may not limit or exclude from

 4-9     coverage a physical or mental condition solely because the

4-10     condition is caused by family violence.

4-11           (d)  A health benefit plan issuer may not treat status as a

4-12     victim of family violence as a preexisting condition.

4-13           (e)  A health benefit plan issuer may not pay a lower fee or

4-14     commission to an agent or broker in relation to issuance or renewal

4-15     of a health benefit plan for a victim of family violence.

4-16           (f)  Notwithstanding any other provision of this article, a

4-17     health benefit plan issuer may underwrite coverage based on an

4-18     individual's physical or mental condition if the health benefit

4-19     plan issuer does not:

4-20                 (1)  consider as part of the underwriting process

4-21     whether an act of family violence caused the condition;

4-22                 (2)  offer coverage to a victim of family violence that

4-23     is different from coverage offered to a person with the same

4-24     physical or mental condition who is not a victim of family

4-25     violence; or

4-26                 (3)  violate any other provision of this code, another

4-27     insurance law of this state, or a rule adopted under this code or

 5-1     another insurance law of this state.

 5-2           Sec. 4.  SANCTIONS.  A health benefit plan issuer who

 5-3     violates this article commits unfair discrimination under Article

 5-4     21.21-6 of this code, as added by Chapter 415, Acts of the 74th

 5-5     Legislature, Regular Session, 1995, and an unfair and deceptive

 5-6     practice under Article 21.21 of this code and is subject to the

 5-7     penalties imposed under those articles.

 5-8           SECTION 2.  Section 14(b), Texas Health Maintenance

 5-9     Organization Act (Article 20A.14, Vernon's Texas Insurance Code),

5-10     is amended to read as follows:

5-11           (b)  Articles 21.21, 21.21A, 21.21-2, [21.21-3,] and 21.21-5,

5-12     Insurance Code; Article 21.21-6, Insurance Code, as added by

5-13     Chapter 415, Acts of the 74th Legislature, Regular Session, 1995;

5-14     and the Unauthorized Insurers False Advertising Process Act

5-15     [Chapter 122, Acts of the 57th Legislature, Regular Session, 1961]

5-16     (Article 21.21-1, Vernon's Texas Insurance Code), apply to health

5-17     maintenance organizations that offer both basic and single health

5-18     care coverages and to basic and single health care plans and the

5-19     evidence of coverage under those plans, except to the extent that

5-20     the commissioner determines that the nature of health maintenance

5-21     organizations and health care plans and evidence of coverage

5-22     renders any provision of those articles clearly inappropriate.

5-23           SECTION 3.  This Act takes effect September 1, 1997, and

5-24     applies only to a health benefit plan that is delivered, issued for

5-25     delivery, or renewed on or after January 1, 1998.  A health benefit

5-26     plan that is delivered, issued for delivery, or renewed before

5-27     January 1, 1998, is governed by the law as it existed immediately

 6-1     before the effective date of this Act, and that law is continued in

 6-2     effect for that purpose.

 6-3           SECTION 4.  The importance of this legislation and the

 6-4     crowded condition of the calendars in both houses create an

 6-5     emergency and an imperative public necessity that the

 6-6     constitutional rule requiring bills to be read on three several

 6-7     days in each house be suspended, and this rule is hereby suspended.