Amend Floor Amendment No. 25 to CSHB 4 by Rose by adding a new
SECTION _____ .01 on page 1 between lines 5 and 6 to read as follows
and renumber subsequent SECTIONS accordingly:
"SECTION _____ .01. Section 3, Article 5.15-1, Insurance
Code, is amended by amending Subsection (d) and adding Subsections
(e) - (g) to read as follows:
(d) Rates shall be reasonable and promote the continued
availability of professional liability coverage for physicians and
health care providers through stability from year to year. Rates
may [and shall] not be excessive or inadequate, as defined in this
subsection, or [nor shall they be] unfairly discriminatory. No
rate shall be held to be excessive unless the rate is unreasonably
high for the insurance coverage provided [and a reasonable degree
of competition does not exist in the area with respect to the
classification to which the rate is applicable]. No rate shall be
held to be inadequate unless the rate is unreasonably low for the
insurance coverage provided and is insufficient to sustain
projected losses and expenses; or unless the rate is unreasonably
low for the insurance coverage provided and the use of the rate has
or, if continued, will have the effect of destroying competition or
creating a monopoly.
(e) After notice and hearing, the commissioner shall
establish a system of rate classifications for professional
liability insurance for physicians and health care providers, based
on risk factors, and require an insurer, a self-insurance trust
authorized under Article 21.49-4 of this code, and the joint
underwriting association established under Article 21.49-3 of this
code to use those classifications. The commissioner shall classify
rates based on the following factors and prescribe and respective
weight to be given each factor:
(1) the impact of risk management courses taken by
physicians and health care providers in this state;
(2) the insured's medical or health care
specialization;
(3) the insured's certification by any certification
entity approved by the American Board of Medical Specialities;
(4) the number of years of medical experience the
insured has had after graduating from an approved medical school or
residency program, if applicable;
(5) the frequency and amount of indemnity payments made
by or on behalf of the insured for any death, injury, or medical or
health care incident in which the insured was determined to be
primarily at fault;
(6) the medical disciplinary history of the insured as
recorded by the Texas State Board of Medical Examiners or a similar
licensing body in another state, if applicable; and
(7) any other factor substantially related to the risk
of loss adopted by the commissioner by rule.
(f) The commissioner by rule shall establish a good doctor
discount program for physicians who have few indemnity payments
relative to others in their specialty. The commissioner may
establish other eligibility factors directly related to the risk of
loss and quality of patient care.
(g) The rate charged for a good doctor discount policy must:
(1) comply with Subsection (e) of this section; and
(2) be an appropriate reduction, as determined by the
commissioner."