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.