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.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
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.