By Olivo H.B. No. 3472
76R8732 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefit plan coverage for certain individuals
1-3 who are not residents of this state.
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 21.52I to read as follows:
1-7 Art. 21.52I. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN
1-8 NONRESIDENTS
1-9 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-10 means a health benefit plan described by Section 2 of this article.
1-11 Sec. 2. SCOPE OF ARTICLE. This article applies only to a
1-12 health benefit plan that provides benefits for medical or surgical
1-13 expenses incurred as a result of a health condition, accident, or
1-14 sickness, including an individual, group, blanket, or franchise
1-15 insurance policy or insurance agreement, a group hospital service
1-16 contract, or an individual or group evidence of coverage or similar
1-17 coverage document that is offered by:
1-18 (1) an insurance company;
1-19 (2) a group hospital service corporation operating
1-20 under Chapter 20 of this code;
1-21 (3) a fraternal benefit society operating under
1-22 Chapter 10 of this code;
1-23 (4) a stipulated premium insurance company operating
1-24 under Chapter 22 of this code;
2-1 (5) a reciprocal exchange operating under Chapter 19
2-2 of this code;
2-3 (6) a health maintenance organization operating under
2-4 the Texas Health Maintenance Organization Act (Chapter 20A,
2-5 Vernon's Texas Insurance Code);
2-6 (7) a multiple employer welfare arrangement that holds
2-7 a certificate of authority under Article 3.95-2 of this code; or
2-8 (8) an approved nonprofit health corporation that
2-9 holds a certificate of authority issued by the commissioner under
2-10 Article 21.52F of this code.
2-11 Sec. 3. COVERAGE FOR CERTAIN NONRESIDENTS. (a) A health
2-12 benefit plan may provide nonresident coverage under this article
2-13 for an individual who:
2-14 (1) purchases the coverage in this state or is
2-15 eligible for the coverage because of an employment relationship or
2-16 other relationship to an individual or entity in this state;
2-17 (2) is not a resident of this state or another state
2-18 of the United States; and
2-19 (3) is not a citizen of the United States.
2-20 (b) Nonresident coverage may be issued under this article to
2-21 any individual described by Subsection (a) of this section,
2-22 including an individual who:
2-23 (1) is a member of a group who would otherwise be
2-24 eligible for coverage under a group health benefit plan; and
2-25 (2) would otherwise be eligible for dependent coverage
2-26 under a health benefit plan.
2-27 Sec. 4. APPLICATION OF OTHER LAW. Nonresident coverage
3-1 issued under this article is subject to this code and the other
3-2 insurance laws of this state except that, notwithstanding any other
3-3 law, coverage under the plan, other than coverage for emergency
3-4 care, may be limited to benefits for goods and services provided in
3-5 this state.
3-6 Sec. 5. RULES. The commissioner may adopt rules to
3-7 implement this article.
3-8 SECTION 2. Section 2(c), Article 4.11, Insurance Code, is
3-9 amended to read as follows:
3-10 (c)(1) "Gross premiums" are the total gross amount of all
3-11 premiums, membership fees, assessments, dues, and any other
3-12 considerations for such insurance received during the taxable year
3-13 on each and every kind of such insurance policy or contract
3-14 covering persons located in the State of Texas and arising from the
3-15 types of insurance specified in Section 1 of this article, but
3-16 deducting returned premiums, any dividends applied to purchase
3-17 paid-up additions to insurance or to shorten the endowment or
3-18 premium payment period, and excluding those premiums received from
3-19 insurance carriers for reinsurance and there shall be no deduction
3-20 for premiums paid for reinsurance. For purposes of this article, a
3-21 stop-loss or excess loss insurance policy issued to a health
3-22 maintenance organization, as defined under the Texas Health
3-23 Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance
3-24 Code), shall be considered reinsurance. Such gross premiums shall
3-25 not include premiums received from the Treasury of the State of
3-26 Texas or from the Treasury of the United States for insurance
3-27 contracted for by the state or federal government for the purpose
4-1 of providing welfare benefits to designated welfare recipients or
4-2 for insurance contracted for by the state or federal government in
4-3 accordance with or in furtherance of the provisions of Title 2,
4-4 Human Resources Code, or the Federal Social Security Act.
4-5 (2) The gross premiums receipts [so] reported as
4-6 described by Subdivision (1) of this subsection shall not include
4-7 the amount of premiums paid on group health, accident, and life
4-8 policies in which the group covered by the policy consists of a
4-9 single nonprofit trust established to provide coverage primarily
4-10 for municipal or county employees of this state.
4-11 (3) The gross premiums receipts reported as described
4-12 by Subdivision (1) of this subsection shall not include the amount
4-13 of premiums that are attributable to nonresident coverage issued
4-14 under Article 21.52I of this code. This subdivision expires
4-15 December 31, 2005.
4-16 SECTION 3. (a) Except as provided by Subsection (b) of this
4-17 section, this Act takes effect September 1, 1999.
4-18 (b) Section 2 of this Act takes effect January 1, 2000.
4-19 (c) The change in law made by Article 21.52I, Insurance
4-20 Code, as added by this Act, applies only to a health benefit plan
4-21 that is delivered, issued for delivery, or renewed on or after
4-22 January 1, 2000. A health benefit plan that is delivered, issued
4-23 for delivery, or renewed before January 1, 2000, is governed by
4-24 the law as it existed immediately before the effective date of this
4-25 Act, and that law is continued in effect for this purpose.
4-26 (d) The change in law made by Section 2 of this Act applies
4-27 only to a premium tax imposed under Article 4.11, Insurance Code,
5-1 as amended by this Act, beginning January 1, 2000. A tax imposed
5-2 under that article before January 1, 2000, is governed by the law
5-3 that existed in the tax year in which that tax was imposed, and
5-4 that law is continued in effect for that purpose.
5-5 SECTION 4. The importance of this legislation and the
5-6 crowded condition of the calendars in both houses create an
5-7 emergency and an imperative public necessity that the
5-8 constitutional rule requiring bills to be read on three several
5-9 days in each house be suspended, and this rule is hereby suspended.