1-1 By: Chisum (Senate Sponsor - Bivins) H.B. No. 2146 1-2 (In the Senate - Received from the House April 30, 2001; 1-3 May 1, 2001, read first time and referred to Committee on Business 1-4 and Commerce; May 11, 2001, reported adversely, with favorable 1-5 Committee Substitute by the following vote: Yeas 7, Nays 0; 1-6 May 11, 2001, sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR H.B. No. 2146 By: Sibley 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to provision of certain health benefit claims information 1-11 to employers. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-14 amended by adding Article 21.49-19 to read as follows: 1-15 Art. 21.49-19. HEALTH BENEFIT CLAIM COST INFORMATION 1-16 REQUIRED TO BE PROVIDED TO EMPLOYER 1-17 Sec. 1. DEFINITION OF GROUP HEALTH BENEFIT PLAN. (a) In 1-18 this article, "group health benefit plan" means a plan that 1-19 provides benefits for medical or surgical expenses incurred as a 1-20 result of a health condition, accident, or sickness, including a 1-21 group, blanket, or franchise insurance policy or insurance 1-22 agreement, a group hospital service contract, or a group evidence 1-23 of coverage or similar group coverage document that is offered by: 1-24 (1) an insurance company; 1-25 (2) a group hospital service corporation operating 1-26 under Chapter 20 of this code; 1-27 (3) a fraternal benefit society operating under 1-28 Chapter 10 of this code; 1-29 (4) a stipulated premium insurance company operating 1-30 under Chapter 22 of this code; 1-31 (5) a reciprocal exchange operating under Chapter 19 1-32 of this code; 1-33 (6) a health maintenance organization operating under 1-34 the Texas Health Maintenance Organization Act (Chapter 20A, 1-35 Vernon's Texas Insurance Code); 1-36 (7) a multiple employer welfare arrangement that holds 1-37 a certificate of authority under Article 3.95-2 of this code; or 1-38 (8) an approved nonprofit health corporation that 1-39 holds a certificate of authority under Article 21.52F of this code. 1-40 (b) The term "group health benefit plan" includes a small 1-41 employer health benefit plan written under Chapter 26 of this code. 1-42 Sec. 2. APPLICABILITY OF ARTICLE. This article applies only 1-43 to a group health benefit plan issued to provide health benefits to 1-44 the employees of one or more employers that sponsor the plan. 1-45 Sec. 3. CLAIM COST INFORMATION. (a) On the request of an 1-46 employer sponsoring a group health benefit plan, the issuer of the 1-47 plan shall provide to the employer the claims cost information for 1-48 employees covered by the plan during the preceding calendar year. 1-49 The information must be reported separately for each month during 1-50 which the plan was in effect. 1-51 (b) Claims cost information provided under this section may 1-52 be provided either in the aggregate or on a detailed basis, but may 1-53 not include: 1-54 (1) any information through which a specific 1-55 individual enrolled in the group health benefit plan may be 1-56 identified; or 1-57 (2) diagnosis codes or other information through which 1-58 a diagnosis of a specific individual enrolled in the group health 1-59 benefit plan may be identified. 1-60 (c) Information obtained by the employer under this section 1-61 is confidential and may be used by the employer only for purposes 1-62 relating to obtaining and maintaining group health benefit plan 1-63 coverage for the employer's employees. 1-64 SECTION 2. This Act takes effect September 1, 2001, and 2-1 applies only to a group health benefit plan that is delivered, 2-2 issued for delivery, or renewed on or after January 1, 2002. A 2-3 plan that is delivered, issued for delivery, or renewed before 2-4 January 1, 2002, is governed by the law as it existed immediately 2-5 before the effective date of this Act, and that law is continued in 2-6 effect for that purpose. 2-7 * * * * *