By Averitt H.B. No. 3275
76R1801 AJA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the application of the preexisting condition provisions
1-3 of certain health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Section 1(H)(4)(a), Chapter 397, Acts of the 54th
1-6 Legislature, Regular Session, 1955 (Article 3.70-1, Vernon's Texas
1-7 Insurance Code), is amended to read as follows:
1-8 (a) A preexisting condition provision in an individual
1-9 health insurance policy shall not apply to an individual who was
1-10 continuously covered for an aggregate period of 18 months by
1-11 creditable coverage that was in effect up to a date not more than
1-12 110 [63] days before the effective date of the individual coverage,
1-13 excluding any waiting period, and whose most recent creditable
1-14 coverage was under a group health plan, governmental plan, or
1-15 church plan.
1-16 SECTION 2. Section 10(a), Article 3.77, Insurance Code, is
1-17 amended to read as follows:
1-18 (a) Any individual person who is and continues to be a
1-19 resident of Texas and a citizen of the United States shall be
1-20 eligible for coverage from the pool if evidence is provided of:
1-21 (1) a notice of rejection or refusal to issue
1-22 substantially similar insurance for health reasons by two insurers.
1-23 A rejection or refusal by an insurer offering only stop-loss,
1-24 excess loss, or reinsurance coverage with respect to the applicant
2-1 shall not be sufficient evidence under this subsection;
2-2 (2) an offer to issue insurance only with conditional
2-3 riders;
2-4 (3) a refusal by an insurer to issue insurance except
2-5 at a rate exceeding the pool rate;
2-6 (4) the individual's maintenance of health insurance
2-7 coverage for the previous 18 months with no gap in coverage greater
2-8 than 110 [63] days of which the most recent coverage was through an
2-9 employer sponsored plan; or
2-10 (5) diagnosis of the individual with one of the
2-11 medical or health conditions listed by the board under Section 6(c)
2-12 of this article and for which a person shall be eligible for pool
2-13 coverage without applying for health insurance coverage.
2-14 SECTION 3. Section 12(b), Article 3.77, Insurance Code, is
2-15 amended to read as follows:
2-16 (b) A preexisting condition provision shall not apply to an
2-17 individual who was continuously covered for an aggregate period of
2-18 12 months by health insurance that was in effect up to a date not
2-19 more than 110 [63] days before the effective date of coverage under
2-20 the pool, excluding any waiting period, provided that the
2-21 application for pool coverage is made no later than 110 [63] days
2-22 following the termination of coverage.
2-23 SECTION 4. Article 3.95-4.8(e), Insurance Code, is amended
2-24 to read as follows:
2-25 (e) A preexisting condition provision in a multiple employer
2-26 welfare arrangement's plan document may not apply to an individual
2-27 who was continuously covered for an aggregate period of 12 months
3-1 under creditable coverage that was in effect up to a date not more
3-2 than 110 [63] days before the effective date of coverage under the
3-3 health benefit plan, excluding any waiting period.
3-4 SECTION 5. Article 26.49(e), Insurance Code, is amended to
3-5 read as follows:
3-6 (e) A preexisting condition provision in a small employer
3-7 health benefit plan may not apply to an individual who was
3-8 continuously covered for an aggregate period of 12 months under
3-9 creditable coverage that was in effect up to a date not more than
3-10 110 [63] days before the effective date of coverage under the small
3-11 employer health benefit plan, excluding any waiting period.
3-12 SECTION 6. Article 26.90(e), Insurance Code, is amended to
3-13 read as follows:
3-14 (e) A preexisting condition provision in a large employer
3-15 health benefit plan shall not apply to an individual who was
3-16 continuously covered for an aggregate period of 12 months under
3-17 creditable coverage that was in effect up to a date not more than
3-18 110 [63] days before the effective date of coverage under the large
3-19 employer health benefit plan, excluding any waiting period.
3-20 SECTION 7. This Act takes effect September 1, 1999, and
3-21 applies only to the application of a preexisting condition
3-22 provision in a health benefit plan that is delivered, issued for
3-23 delivery, or renewed on or after January 1, 2000. A preexisting
3-24 condition in a health benefit plan that is delivered, issued for
3-25 delivery, or renewed before January 1, 2000, is governed by the law
3-26 as it existed immediately before the effective date of this Act,
3-27 and that law is continued in effect for that purpose.
4-1 SECTION 8. The importance of this legislation and the
4-2 crowded condition of the calendars in both houses create an
4-3 emergency and an imperative public necessity that the
4-4 constitutional rule requiring bills to be read on three several
4-5 days in each house be suspended, and this rule is hereby suspended.