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