By Pitts H.B. No. 256
76R1831 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to copayment information required on certain health
1-3 coverage identification cards.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.52H to read as follows:
1-7 Art. 21.52H. COPAYMENT INFORMATION ON HEALTH COVERAGE
1-8 IDENTIFICATION CARDS
1-9 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-10 means a plan described by Section 2 of this article.
1-11 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-12 a health benefit plan that:
1-13 (1) provides benefits for medical or surgical expenses
1-14 incurred as a result of a health condition, accident, or sickness,
1-15 including:
1-16 (A) an individual, group, blanket, or franchise
1-17 insurance policy or insurance agreement, a group hospital service
1-18 contract, or an individual or group evidence of coverage that is
1-19 offered by:
1-20 (i) an insurance company;
1-21 (ii) a group hospital service corporation
1-22 operating under Chapter 20 of this code;
1-23 (iii) a fraternal benefit society
1-24 operating under Chapter 10 of this code;
2-1 (iv) a stipulated premium insurance
2-2 company operating under Chapter 22 of this code; or
2-3 (v) a health maintenance organization
2-4 operating under the Texas Health Maintenance Organization Act
2-5 (Chapter 20A, Vernon's Texas Insurance Code); or
2-6 (B) to the extent permitted by the Employee
2-7 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-8 seq.), a health benefit plan that is offered by:
2-9 (i) a multiple employer welfare
2-10 arrangement as defined by Section 3, Employee Retirement Income
2-11 Security Act of 1974 (29 U.S.C. Section 1002);
2-12 (ii) any other entity not licensed under
2-13 this code or another insurance law of this state that contracts
2-14 directly for health care services on a risk-sharing basis,
2-15 including an entity that contracts for health care services on a
2-16 capitation basis; or
2-17 (iii) another analogous benefit
2-18 arrangement;
2-19 (2) is offered by an approved nonprofit health
2-20 corporation that is certified under Section 5.01(a), Medical
2-21 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-22 that holds a certificate of authority issued by the commissioner
2-23 under Article 21.52F of this code;
2-24 (3) is a small employer health benefit plan written
2-25 under Chapter 26 of this code; or
2-26 (4) is offered through a Medicare supplemental policy
2-27 as defined by Section 1882(g)(1), Social Security Act (42 U.S.C.
3-1 Section 1395ss).
3-2 (b) This article does not apply to:
3-3 (1) a plan that provides coverage:
3-4 (A) only for a specified disease or other
3-5 limited benefit;
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;
3-10 (D) as a supplement to liability insurance;
3-11 (E) for credit insurance;
3-12 (F) only for dental or vision care; or
3-13 (G) only for indemnity for hospital confinement
3-14 or other hospital expenses;
3-15 (2) workers' compensation insurance coverage;
3-16 (3) medical payment insurance issued as part of a
3-17 motor vehicle insurance policy; or
3-18 (4) a long-term care policy, including a nursing home
3-19 fixed indemnity policy, unless the commissioner determines that the
3-20 policy provides benefit coverage so comprehensive that the policy
3-21 is a health benefit plan as described by Subsection (a) of this
3-22 section.
3-23 Sec. 3. COPAYMENT INFORMATION. Each health benefit plan
3-24 that issues a health coverage identification card or similar item
3-25 to an insured, beneficiary, or enrollee covered under the plan
3-26 shall include in the information printed on the card or item a
3-27 statement of each type and amount of copayment assessed under the
4-1 plan, including copayments for:
4-2 (1) office visits;
4-3 (2) emergency room care; and
4-4 (3) pharmaceutical coverage, including copayments for
4-5 generic and brand-name prescriptions.
4-6 SECTION 2. Article 21.52H, Insurance Code, as added by this
4-7 Act, applies only to an insurance policy, contract, or evidence of
4-8 coverage delivered, issued for delivery, or renewed on or after
4-9 January 1, 2000. A policy, contract, or evidence of coverage
4-10 delivered, issued for delivery, or renewed before January 1, 2000,
4-11 is governed by the law as it existed immediately before the
4-12 effective date of this Act, and that law is continued in effect for
4-13 that purpose.
4-14 SECTION 3. This Act takes effect September 1, 1999.
4-15 SECTION 4. The importance of this legislation and the
4-16 crowded condition of the calendars in both houses create an
4-17 emergency and an imperative public necessity that the
4-18 constitutional rule requiring bills to be read on three several
4-19 days in each house be suspended, and this rule is hereby suspended.