By Burnam H.B. No. 1685 75R7103 T A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to certain disclosures to the public by health maintenance 1-3 organizations. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Chapter 20A, Insurance Code, is amended by adding 1-6 Article 20A.14A to read as follows: 1-7 ARTICLE 20A.14A. MEDICARE HMO REQUIRED DISCLOSURE. (a) 1-8 Definitions: 1-9 (1) "Applicant" means any person who seeks to obtain 1-10 Medicare benefits from a Medicare HMO. 1-11 (2) "Medicare" means the Health Insurance for the Aged 1-12 Act, Part 1, Title I, Social Security Amendments of 1965, as 1-13 amended. 1-14 (3) "Medicare HMO" means a Health Maintenance 1-15 Organization authorized to provide Medicare benefits as provided by 1-16 federal law. 1-17 (4) "Medical Insurance" means any Medicare supplement 1-18 policy defined by Article 3.74, Section 3, of this code. 1-19 (b) Required disclosures: 1-20 (1) A health maintenance organization that offers or 1-21 provides coverage to Medicare beneficiaries shall include the 1-22 following statement in 10-point bold face type on the first page of 1-23 all materials used in advertising, marketing and explaining the 1-24 health maintenance organization's Medicare coverage: IF YOU ENROLL 2-1 IN THIS MEDICARE HEALTH MAINTENANCE ORGANIZATION AND REMAIN 2-2 ENROLLED FOR MORE THAN SIX MONTHS PAST YOUR SIXTY-FIFTH (65) 2-3 BIRTHDAY, YOU MAY LOSE YOUR OPPORTUNITY TO PURCHASE MEDICARE 2-4 SUPPLEMENT INSURANCE, "MEDIGAP." MEDICARE SUPPLEMENT INSURANCE 2-5 "MEDIGAP" MUST BE OFFERED TO YOU WITHOUT REGARD TO YOUR HEALTH 2-6 STATUS OR PRE-EXISTING CONDITIONS, BUT ONLY DURING THE FIRST SIX 2-7 (6) MONTHS FOLLOWING YOUR SIXTY-FIFTH (65) BIRTHDAY. SIX (6) 2-8 MONTHS AFTER YOUR SIXTY-FIFTH (65) BIRTHDAY, YOU MAY BE DENIED 2-9 MEDICARE SUPPLEMENT INSURANCE "MEDIGAP" OR BE SUBJECT TO HIGHER 2-10 CHARGES OR PREMIUMS BECAUSE OF YOUR MEDICAL HISTORY. MEDICARE 2-11 SUPPLEMENT INSURANCE "MEDIGAP" COVERS MANY OF THE COSTS NOT PAID 2-12 FOR BY THE REGULAR (NON-HMO) MEDICARE PROGRAM. YOU MAY WANT TO 2-13 PURCHASE MEDICARE SUPPLEMENT INSURANCE IF YOU ARE PLANNING TO LEAVE 2-14 THE MEDICARE HMO. BEFORE ENROLLING IN A MEDICARE HMO, CONTACT THE 2-15 LOCAL OFFICE OF THE FEDERAL SOCIAL SECURITY ADMINISTRATION OR 2-16 TELEPHONE THE TEXAS DEPARTMENT ON AGING AT 1-800-252-9240 TO LEARN 2-17 MORE ABOUT YOUR RIGHTS AND OPTIONS UNDER MEDICARE. 2-18 (2) A Medicare HMO shall obtain the signature of the 2-19 applicant acknowledging the receipt of the disclosures required by 2-20 Section (1) of this Article prior to obtaining the Applicant's 2-21 agreement to enroll in a Medicare HMO. 2-22 (a) A Medicare HMO shall send by first class mail a copy of 2-23 the signed acknowledgement required by Section 2 of this Article to 2-24 the Applicant within 15 days of the Applicant enrolling in the 2-25 Medicare HMO. 2-26 (b) A Medicare HMO shall send an enrollee by first class 2-27 mail a copy of the signed acknowledgement required by Section 2 of 3-1 this Article to the enrollee one hundred forty five (145) days 3-2 after the enrollee's sixty fifth (65) birthday. 3-3 (c) The Commissioner shall be authorized to enact rules for 3-4 implementation of this Article. 3-5 SECTION 2. This Act takes effect September 1, 1997 and 3-6 applies to all health maintenance organization Medicare health 3-7 plans delivered, issued for delivery, or renewed after January 1, 3-8 1998. 3-9 SECTION 3. The importance of this legislation and the 3-10 crowded condition of the calendars in both houses create an 3-11 emergency and an imperative public necessity that the 3-12 constitutional rule requiring bills to be read on three several 3-13 days in each house be suspended, and this rule is hereby suspended.