1-1 AN ACT 1-2 relating to provision of certain health benefit claims information 1-3 to employers. 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 21.49-19 to read as follows: 1-7 Art. 21.49-19. HEALTH BENEFIT CLAIM COST INFORMATION 1-8 REQUIRED TO BE PROVIDED TO EMPLOYER 1-9 Sec. 1. DEFINITION OF GROUP HEALTH BENEFIT PLAN. (a) In 1-10 this article, "group health benefit plan" means a plan that 1-11 provides benefits for medical or surgical expenses incurred as a 1-12 result of a health condition, accident, or sickness, including a 1-13 group, blanket, or franchise insurance policy or insurance 1-14 agreement, a group hospital service contract, or a group evidence 1-15 of coverage or similar group coverage document that is offered by: 1-16 (1) an insurance company; 1-17 (2) a group hospital service corporation operating 1-18 under Chapter 20 of this code; 1-19 (3) a fraternal benefit society operating under 1-20 Chapter 10 of this code; 1-21 (4) a stipulated premium insurance company operating 1-22 under Chapter 22 of this code; 1-23 (5) a reciprocal exchange operating under Chapter 19 1-24 of this code; 2-1 (6) a health maintenance organization operating under 2-2 the Texas Health Maintenance Organization Act (Chapter 20A, 2-3 Vernon's Texas Insurance Code); 2-4 (7) a multiple employer welfare arrangement that holds 2-5 a certificate of authority under Article 3.95-2 of this code; or 2-6 (8) an approved nonprofit health corporation that 2-7 holds a certificate of authority under Article 21.52F of this code. 2-8 (b) The term "group health benefit plan" includes a small 2-9 employer health benefit plan written under Chapter 26 of this code. 2-10 Sec. 2. APPLICABILITY OF ARTICLE. This article applies only 2-11 to a group health benefit plan issued to provide health benefits to 2-12 the employees of one or more employers that sponsor the plan. 2-13 Sec. 3. CLAIM COST INFORMATION. (a) On the request of an 2-14 employer sponsoring a group health benefit plan, the issuer of the 2-15 plan shall provide to the employer the claims cost information for 2-16 employees covered by the plan during the preceding calendar year. 2-17 The information must be reported separately for each month during 2-18 which the plan was in effect. 2-19 (b) Claims cost information provided under this section may 2-20 be provided either in the aggregate or on a detailed basis, but may 2-21 not include: 2-22 (1) any information through which a specific 2-23 individual enrolled in the group health benefit plan may be 2-24 identified; or 2-25 (2) diagnosis codes or other information through which 2-26 a diagnosis of a specific individual enrolled in the group health 2-27 benefit plan may be identified. 3-1 (c) Information obtained by the employer under this section 3-2 is confidential and may be used by the employer only for purposes 3-3 relating to obtaining and maintaining group health benefit plan 3-4 coverage for the employer's employees. 3-5 SECTION 2. This Act takes effect September 1, 2001, and 3-6 applies only to a group health benefit plan that is delivered, 3-7 issued for delivery, or renewed on or after January 1, 2002. A 3-8 plan that is delivered, issued for delivery, or renewed before 3-9 January 1, 2002, is governed by the law as it existed immediately 3-10 before the effective date of this Act, and that law is continued in 3-11 effect for that purpose. _______________________________ _______________________________ President of the Senate Speaker of the House I certify that H.B. No. 2146 was passed by the House on April 27, 2001, by a non-record vote; that the House refused to concur in Senate amendments to H.B. No. 2146 on May 25, 2001, and requested the appointment of a conference committee to consider the differences between the two houses; and that the House adopted the conference committee report on H.B. No. 2146 on May 27, 2001, by a non-record vote. _______________________________ Chief Clerk of the House I certify that H.B. No. 2146 was passed by the Senate, with amendments, on May 23, 2001, by a viva-voce vote; at the request of the House, the Senate appointed a conference committee to consider the differences between the two houses; and that the Senate adopted the conference committee report on H.B. No. 2146 on May 27, 2001, by a viva-voce vote. _______________________________ Secretary of the Senate APPROVED: __________________________ Date __________________________ Governor