By Chisum                                             H.B. No. 2146
         77R5630 DLF-D                           
                                A BILL TO BE ENTITLED
 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 CLAIMS INFORMATION REQUIRED TO
 1-8     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.  CLAIMS 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 experience of the
2-16     employees covered by the plan during the preceding calendar year.
2-17           (b)  Claim information provided under this section shall be
2-18     provided in the aggregate, without information through which a
2-19     specific individual enrolled in the group health benefit plan may
2-20     be identified.
2-21           (c)  Information obtained by the employer under this section
2-22     is confidential and may be used by the employer only for purposes
2-23     relating to obtaining and maintaining group health benefit plan
2-24     coverage for the employer's employees.
2-25           SECTION 2. This Act takes effect September 1, 2001, and
2-26     applies only to a group health benefit plan that is delivered,
2-27     issued for delivery, or renewed on or after January 1, 2002.  A
 3-1     plan that is delivered, issued for delivery, or renewed before
 3-2     January 1, 2002, is governed by the law as it existed immediately
 3-3     before the effective date of this Act, and that law is continued in
 3-4     effect for that purpose.