By:  Shapleigh                                         S.B. No. 497
                                A BILL TO BE ENTITLED
                                       AN ACT
 1-1     relating to the application of the preexisting condition provisions
 1-2     of certain health benefit plans.
 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-4           SECTION 1.  Paragraph (a), Subdivision (4), Subsection (H),
 1-5     Section 1, Chapter 397, Acts of the 54th Legislature, Regular
 1-6     Session, 1955 (Article 3.70-1, Vernon's Texas Insurance Code), is
 1-7     amended to read as follows:
 1-8                       (a)  A preexisting condition provision in an
 1-9     individual health insurance policy shall not apply to an individual
1-10     who was continuously covered for an aggregate period of 18 months
1-11     by creditable coverage that was in effect up to a date not more
1-12     than 105 [63] days before the effective date of the individual
1-13     coverage, excluding any waiting period, and whose most recent
1-14     creditable coverage was under a group health plan, governmental
1-15     plan, or church plan.
1-16           SECTION 2.  Subsection (a), Section 10, Article 3.77,
1-17     Insurance Code, is 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 105 [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.  Subsection (b), Section 12, Article 3.77,
2-15     Insurance Code, is 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 105 [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 105 [63] days
2-22     following the termination of coverage.
2-23           SECTION 4.  Subsection (e), Article 3.95-4.8, Insurance Code,
2-24     is amended 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
 3-1     who was continuously covered for an aggregate period of 12 months
 3-2     under creditable coverage that was in effect up to a date not more
 3-3     than 105 [63] days before the effective date of coverage under the
 3-4     health benefit plan, excluding any waiting period.
 3-5           SECTION 5.  Subsection (e), Article 26.49, Insurance Code, is
 3-6     amended to read as follows:
 3-7           (e)  A preexisting condition provision in a small employer
 3-8     health benefit plan may not apply to an individual who was
 3-9     continuously covered for an aggregate period of 12 months under
3-10     creditable coverage that was in effect up to a date not more than
3-11     105 [63] days before the effective date of coverage under the small
3-12     employer health benefit plan, excluding any waiting period.
3-13           SECTION 6.  Subsection (e), Article 26.90, Insurance Code, is
3-14     amended to read as follows:
3-15           (e)  A preexisting condition provision in a large employer
3-16     health benefit plan shall not apply to an individual who was
3-17     continuously covered for an aggregate period of 12 months under
3-18     creditable coverage that was in effect up to a date not more than
3-19     105 [63] days before the effective date of coverage under the large
3-20     employer health benefit plan, excluding any waiting period.
3-21           SECTION 7.  This Act takes effect September 1, 1999, and
3-22     applies only to the application of a preexisting condition
3-23     provision in a health benefit plan that is delivered, issued for
3-24     delivery, or renewed on or after January 1, 2000.  A preexisting
3-25     condition provision in a health benefit plan that is delivered,
3-26     issued for delivery, or renewed before January 1, 2000, is governed
 4-1     by the law as it existed immediately before the effective date of
 4-2     this Act, and that law is continued in effect for that purpose.
 4-3           SECTION 8.  The importance of this legislation and the
 4-4     crowded condition of the calendars in both houses create an
 4-5     emergency and an imperative public necessity that the
 4-6     constitutional rule requiring bills to be read on three several
 4-7     days in each house be suspended, and this rule is hereby suspended.