1-1 AN ACT
1-2 relating to requiring a health insurer to provide certain
1-3 information to governmental entities and employers with which the
1-4 insurer contracts.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-7 amended by adding Article 21.49-15 to read as follows:
1-8 Art. 21.49-15. INFORMATION REQUIRED TO BE PROVIDED BY
1-9 INSURER TO GOVERNMENTAL ENTITY WITH WHICH INSURER CONTRACTS
1-10 Sec. 1. DEFINITIONS. In this article:
1-11 (1) "Governmental entity" means a state agency or
1-12 political subdivision of this state.
1-13 (2) "Insurer" means:
1-14 (A) an insurance company;
1-15 (B) a health maintenance organization operating
1-16 under the Texas Health Maintenance Organization Act (Chapter 20A,
1-17 Vernon's Texas Insurance Code); or
1-18 (C) an approved nonprofit health corporation
1-19 that holds a certificate of authority issued by the commissioner
1-20 under Article 21.52F of this code.
1-21 (3) "Political subdivision" means a county,
1-22 municipality, school district, special purpose district, or other
1-23 subdivision of state government that has jurisdiction limited to a
1-24 geographic portion of the state.
2-1 Sec. 2. REQUIRED INFORMATION. (a) Each insurer that enters
2-2 into a contract with a governmental entity that is subject to
2-3 competitive bidding requirements and under which the insurer
2-4 delivers, issues for delivery, or renews a policy or contract for
2-5 health insurance or an evidence of coverage shall provide to the
2-6 governmental entity a detailed report that includes:
2-7 (1) the claims experience of the governmental entity
2-8 during the preceding calendar year; and
2-9 (2) the dollar amount of each large claim, as defined
2-10 by the governmental entity, paid by the insurer under the contract
2-11 during the preceding calendar year.
2-12 (b) Claim information provided by an insurer to the
2-13 governmental entity under this section:
2-14 (1) shall be provided in the aggregate, without
2-15 information through which a specific individual covered by the
2-16 health insurance or evidence of coverage may be identified;
2-17 (2) may be viewed or used only for contract bidding
2-18 purposes; and
2-19 (3) is confidential for purposes of Chapter 552,
2-20 Government Code.
2-21 SECTION 2. Subchapter H, Chapter 26, Insurance Code, is
2-22 amended by adding Article 26.96 to read as follows:
2-23 Art. 26.96. REPORTING OF CLAIMS INFORMATION. (a) This
2-24 article applies only to an insured employer health benefit plan.
2-25 (b) An employer carrier, on written request from an insured
2-26 employer covered by that carrier, shall report to the employer
2-27 information from the 12 months preceding the date of the report
3-1 regarding:
3-2 (1) the total amount of charges submitted to the
3-3 carrier for persons covered under the employer health benefit plan;
3-4 (2) the total amount of payments made by the carrier
3-5 to health care providers for persons covered under the plan; and
3-6 (3) to the extent available, information on claims
3-7 paid by type of health care provider, including the total hospital
3-8 charges, physician charges, pharmaceutical charges, and other
3-9 charges.
3-10 (c) An employer carrier shall provide information requested
3-11 by an employer under this article annually not later than the 30th
3-12 day before the anniversary or renewal date of the employer's health
3-13 benefit plan.
3-14 (d) Notwithstanding Subsection (c) of this article, an
3-15 employer is not required to provide information under Subsection
3-16 (b) of this article earlier than the 30th day after the date of the
3-17 initial written request.
3-18 (e) An employer carrier may not report any information
3-19 required under this article the release of which is prohibited by
3-20 federal law or regulation.
3-21 (f) Claim information provided by an employer carrier under
3-22 this section shall be provided in the aggregate, without
3-23 information through which a specific individual covered by the
3-24 health insurance or evidence of coverage may be identified.
3-25 SECTION 3. Article 21.49-15, Insurance Code, as added by
3-26 this Act, applies only to a contract entered into on or after the
3-27 effective date of this Act. A contract entered into before that
4-1 date is governed by the law as it existed immediately before the
4-2 effective date of this Act, and that law is continued in effect for
4-3 that purpose.
4-4 SECTION 4. Article 26.96, Insurance Code, as added by this
4-5 Act, applies only to a contract entered into on or after the
4-6 effective date of this Act. A contract entered into before that
4-7 date is governed by the law as it existed immediately before the
4-8 effective date of this Act, and that law is continued in effect for
4-9 that purpose.
4-10 SECTION 5. This Act takes effect September 1, 1999.
4-11 SECTION 6. The importance of this legislation and the
4-12 crowded condition of the calendars in both houses create an
4-13 emergency and an imperative public necessity that the
4-14 constitutional rule requiring bills to be read on three several
4-15 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1628 was passed by the House on May
11, 1999, by a non-record vote; and that the House concurred in
Senate amendments to H.B. No. 1628 on May 22, 1999, by a non-record
vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 1628 was passed by the Senate, with
amendments, on May 20, 1999, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor