1-1 By: Shapleigh S.B. No. 497
1-2 (In the Senate - Filed February 12, 1999; February 15, 1999,
1-3 read first time and referred to Committee on Economic Development;
1-4 April 23, 1999, reported adversely, with favorable Committee
1-5 Substitute by the following vote: Yeas 5, Nays 0; April 23, 1999,
1-6 sent to printer.)
1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 497 By: Armbrister
1-8 A BILL TO BE ENTITLED
1-9 AN ACT
1-10 relating to the application of the preexisting condition provisions
1-11 of certain health benefit plans.
1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13 SECTION 1. Paragraph (a), Subdivision (4), Subsection (H),
1-14 Section 1, Chapter 397, Acts of the 54th Legislature, Regular
1-15 Session, 1955 (Article 3.70-1, Vernon's Texas Insurance Code), is
1-16 amended to read as follows:
1-17 (a) A preexisting condition provision in an
1-18 individual health insurance policy shall not apply to an individual
1-19 who was continuously covered for an aggregate period of 18 months
1-20 by creditable coverage that was in effect up to a date not more
1-21 than 105 [63] days before the effective date of the individual
1-22 coverage, excluding any waiting period, and whose most recent
1-23 creditable coverage was under a group health plan, governmental
1-24 plan, or church plan.
1-25 SECTION 2. Subsection (a), Section 10, Article 3.77,
1-26 Insurance Code, is amended to read as follows:
1-27 (a) Any individual person who is and continues to be a
1-28 resident of Texas and a citizen of the United States shall be
1-29 eligible for coverage from the pool if evidence is provided of:
1-30 (1) a notice of rejection or refusal to issue
1-31 substantially similar insurance for health reasons by two insurers.
1-32 A rejection or refusal by an insurer offering only stop-loss,
1-33 excess loss, or reinsurance coverage with respect to the applicant
1-34 shall not be sufficient evidence under this subsection;
1-35 (2) an offer to issue insurance only with conditional
1-36 riders;
1-37 (3) a refusal by an insurer to issue insurance except
1-38 at a rate exceeding the pool rate;
1-39 (4) the individual's maintenance of health insurance
1-40 coverage for the previous 18 months with no gap in coverage greater
1-41 than 105 [63] days of which the most recent coverage was through an
1-42 employer sponsored plan; or
1-43 (5) diagnosis of the individual with one of the
1-44 medical or health conditions listed by the board under Section 6(c)
1-45 of this article and for which a person shall be eligible for pool
1-46 coverage without applying for health insurance coverage.
1-47 SECTION 3. Subsection (b), Section 12, Article 3.77,
1-48 Insurance Code, is amended to read as follows:
1-49 (b) A preexisting condition provision shall not apply to an
1-50 individual who was continuously covered for an aggregate period of
1-51 12 months by health insurance that was in effect up to a date not
1-52 more than 105 [63] days before the effective date of coverage under
1-53 the pool, excluding any waiting period, provided that the
1-54 application for pool coverage is made no later than 105 [63] days
1-55 following the termination of coverage.
1-56 SECTION 4. Subsection (e), Article 3.95-4.8, Insurance Code,
1-57 is amended to read as follows:
1-58 (e) A preexisting condition provision in a multiple employer
1-59 welfare arrangement's plan document may not apply to an individual
1-60 who was continuously covered for an aggregate period of 12 months
1-61 under creditable coverage that was in effect up to a date not more
1-62 than 105 [63] days before the effective date of coverage under the
1-63 health benefit plan, excluding any waiting period.
1-64 SECTION 5. Subsection (e), Article 26.49, Insurance Code, is
2-1 amended to read as follows:
2-2 (e) A preexisting condition provision in a small employer
2-3 health benefit plan may not apply to an individual who was
2-4 continuously covered for an aggregate period of 12 months under
2-5 creditable coverage that was in effect up to a date not more than
2-6 105 [63] days before the effective date of coverage under the small
2-7 employer health benefit plan, excluding any waiting period.
2-8 SECTION 6. Subsection (e), Article 26.90, Insurance Code, is
2-9 amended to read as follows:
2-10 (e) A preexisting condition provision in a large employer
2-11 health benefit plan shall not apply to an individual who was
2-12 continuously covered for an aggregate period of 12 months under
2-13 creditable coverage that was in effect up to a date not more than
2-14 105 [63] days before the effective date of coverage under the large
2-15 employer health benefit plan, excluding any waiting period.
2-16 SECTION 7. This Act takes effect September 1, 1999, and
2-17 applies only to the application of a preexisting condition
2-18 provision in a health benefit plan that is delivered, issued for
2-19 delivery, or renewed on or after January 1, 2000. A preexisting
2-20 condition provision in a health benefit plan that is delivered,
2-21 issued for delivery, or renewed before January 1, 2000, is governed
2-22 by the law as it existed immediately before the effective date of
2-23 this Act, and that law is continued in effect for that purpose.
2-24 SECTION 8. The importance of this legislation and the
2-25 crowded condition of the calendars in both houses create an
2-26 emergency and an imperative public necessity that the
2-27 constitutional rule requiring bills to be read on three several
2-28 days in each house be suspended, and this rule is hereby suspended.
2-29 * * * * *