75R10742 SAW-F                           

         By Eiland                                             H.B. No. 2092

         Substitute the following for H.B. No. 2092:

         By Eiland                                         C.S.H.B. No. 2092

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to advertisements for certain health benefit plans.

 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-4           SECTION 1.  Subchapter B, Chapter 21, Insurance Code, is

 1-5     amended by adding Article 21.20-2 to read as follows:

 1-6           Art. 21.20-2.  ADVERTISEMENTS FOR CERTAIN HEALTH BENEFIT

 1-7     PLANS

 1-8           Sec. 1.  SCOPE OF ARTICLE.  (a)  This article applies only to

 1-9     a health benefit plan that provides benefits for medical or

1-10     surgical expenses incurred as a result of a health condition,

1-11     accident, or sickness, including an individual, group, blanket, or

1-12     franchise insurance policy or agreement, a group hospital service

1-13     contract, or an individual or group evidence of coverage issued by:

1-14                 (1)  an insurance company;

1-15                 (2)  a group hospital service corporation operating

1-16     under Chapter 20 of this code;

1-17                 (3)  a health maintenance organization operating under

1-18     the Texas Health Maintenance Organization Act (Chapter 20A,

1-19     Vernon's Texas Insurance Code); or

1-20                 (4)  an approved nonprofit health corporation that is

1-21     certified under Section 5.01(a), Medical Practice Act (Article

1-22     4495b, Vernon's Texas Civil Statutes), and that holds a certificate

1-23     of authority issued by the commissioner under Article 21.52F of

1-24     this code.

 2-1           (b)  This article does not apply to:

 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     or

 2-6                       (C)  for wages or payments in lieu of wages for a

 2-7     period during which an employee is absent from work because of

 2-8     sickness or injury; or

 2-9                 (2)  a long-term care policy, including a nursing home

2-10     fixed indemnity policy, unless the commissioner determines that the

2-11     policy provides benefit coverage so comprehensive that the policy

2-12     meets the definition of a health benefit plan under Subsection (a)

2-13     of this section.

2-14           Sec. 2.  DISCLAIMERS.  Notwithstanding  Article 21.21 of this

2-15     code, an advertisement for a health benefit plan may include rate

2-16     information without including information about all benefit

2-17     exclusions and limitations if the advertisement includes prominent

2-18     disclaimers that clearly indicate that:

2-19                 (1)  the rates are illustrative;

2-20                 (2)  a person should not send money to the issuer of

2-21     the health benefit plan in response to the advertisement;

2-22                 (3)  a person cannot obtain coverage under the health

2-23     benefit plan until the person completes an application for

2-24     coverage; and

2-25                 (4)  benefit exclusions and limitations may apply to

2-26     the health benefit plan.

2-27           SECTION 2.  The importance of this legislation and the

 3-1     crowded condition of the calendars in both houses create an

 3-2     emergency and an imperative public necessity that the

 3-3     constitutional rule requiring bills to be read on three several

 3-4     days in each house be suspended, and this rule is hereby suspended,

 3-5     and that this Act take effect and be in force from and after its

 3-6     passage, and it is so enacted.