By Smithee H.B. No. 2827
77R7900 PB-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to consumer disclosures required to be made by health
1-3 maintenance organizations and insurers who provide preferred
1-4 provider plans.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. The Texas Health Maintenance Organization Act
1-7 (Chapter 20A, Vernon's Texas Insurance Code) is amended by adding
1-8 Section 11C to read as follows:
1-9 Sec. 11C. ADDITIONAL REQUIRED DISCLOSURES. (a) To allow a
1-10 current or prospective group contract holder and current or
1-11 prospective enrollee eligible for enrollment in a health care plan
1-12 to make comparisons and informed decisions before selecting among
1-13 health care plans, each health maintenance organization shall
1-14 provide an accurate written disclosure of the information described
1-15 by Subsection (b) of this section in the health maintenance
1-16 organization's:
1-17 (1) health care plan terms and conditions;
1-18 (2) current list of physicians and providers; and
1-19 (3) handbook.
1-20 (b) For any physician or provider listed under a certain
1-21 specialty of physician or type of provider in the current list of
1-22 physicians and providers, the health maintenance organization shall
1-23 disclose any limitation or condition on enrollee access to that
1-24 physician or provider that is not applicable to other physicians or
2-1 providers listed under the same specialty or type of practice.
2-2 (c) The health maintenance organization shall disclose any
2-3 practice used by the health maintenance organization, through case
2-4 management or otherwise, to attempt to persuade, direct, or
2-5 otherwise encourage an enrollee to use the services of a particular
2-6 physician or provider and the identity of those physicians or
2-7 providers.
2-8 (d) A health maintenance organization may not limit or
2-9 condition an enrollee's access to any physician or provider as
2-10 described by Subsection (b) of this section, or attempt to
2-11 persuade, direct, or otherwise encourage an enrollee to use the
2-12 services of a particular physician or provider as described by
2-13 Subsection (c) of this section, unless the health maintenance
2-14 organization has made the disclosure required by this section. The
2-15 disclosure must be conspicuous, printed in 14-point boldfaced type
2-16 or 14-point uppercase typewritten letters, and printed on a page
2-17 entitled "DISCLOSURES" that immediately follows the title page of
2-18 the health care plan terms and conditions, current list of
2-19 physicians and providers, and handbook.
2-20 (e) This section does not apply to limited provider
2-21 networks.
2-22 SECTION 2. Section 6(c), Article 3.70-3C, Insurance Code, as
2-23 added by Chapter 1024, Acts of the 75th Legislature, Regular
2-24 Session, 1997, is amended to read as follows:
2-25 (c) A current list of preferred providers shall be updated
2-26 and provided to all insureds on at least a quarterly basis [no less
2-27 than annually].
3-1 SECTION 3. Article 3.70-3C, Insurance Code, as added by
3-2 Chapter 1024, Acts of the 75th Legislature, Regular Session, 1997,
3-3 is amended by adding Section 6A to read as follows:
3-4 Sec. 6A. ADDITIONAL REQUIRED DISCLOSURES. (a) To allow a
3-5 current or prospective group contract holder and current or
3-6 prospective insured to make comparisons and informed decisions
3-7 before selecting among health care plans, each insurer shall
3-8 provide an accurate written disclosure of the information described
3-9 by Subsection (b) of this section in the insurer's:
3-10 (1) insurance policy;
3-11 (2) current list of preferred providers; and
3-12 (3) handbook, if applicable.
3-13 (b) For any physician or provider listed under a certain
3-14 specialty of physician or type of provider in the current list of
3-15 physicians and providers, the insurer shall disclose any limitation
3-16 or condition on an insured's access to that physician or provider
3-17 that is not applicable to other physicians or providers listed
3-18 under the same specialty or type of practice.
3-19 (c) The insurer shall disclose any practice used by the
3-20 insurer, through case management or otherwise, to attempt to
3-21 persuade, direct, or otherwise encourage an insured to use the
3-22 services of a particular physician or provider and the identity of
3-23 those physicians or providers.
3-24 (d) An insurer may not limit or condition an insured's
3-25 access to any physician or provider as described by Subsection (b)
3-26 of this section, or attempt to persuade, direct, or otherwise
3-27 encourage an insured to use the services of a particular physician
4-1 or provider as described by Subsection (c) of this section, unless
4-2 the insurer has made the disclosure required by this section. The
4-3 disclosure must be conspicuous, printed in 14-point boldfaced type
4-4 or 14-point uppercase typewritten letters, and printed on a page
4-5 entitled "DISCLOSURES" that immediately follows the title page of
4-6 the terms and conditions of the policy, current list of preferred
4-7 providers, and handbook, if applicable.
4-8 SECTION 4. This Act applies only to an insurance policy,
4-9 contract, or evidence of coverage delivered, issued for delivery,
4-10 or renewed on or after January 1, 2002. A policy, contract, or
4-11 evidence of coverage delivered, issued for delivery, or renewed
4-12 before January 1, 2002, is governed by the law as it existed
4-13 immediately before the effective date of this Act, and that law is
4-14 continued in effect for that purpose.
4-15 SECTION 5. This Act takes effect September 1, 2001.