This website will be unavailable from Thursday, May 30, 2024 at 6:00 p.m. through Monday, June 3, 2024 at 7:00 a.m. due to data center maintenance.


                                                                                

78R5200 KCR-F

By:  Seaman                                                       H.B. No. 1267


A BILL TO BE ENTITLED
AN ACT
relating to small employer health benefit plans. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: SECTION 1. Article 26.44A, Insurance Code, is amended to read as follows: Art. 26.44A. BENEFIT PLANS. (a) The commissioner by rule shall establish the coverage requirements for the catastrophic care benefit plan and the basic coverage benefit plan. The commissioner shall: (1) develop prototype policies including both basic and catastrophic coverage for use by small employer carriers; or (2) promulgate standards describing [that include] all [contractual] provisions required to produce an entire contract for basic or catastrophic coverage [in accordance with this article and this code]. (b) The [Coverage under the] catastrophic care benefit plan must [be designed to] provide necessary coverage in the event of catastrophic illness or injury. [The commissioner shall establish deductibles and coinsurance requirements at levels that permit options for the insured to obtain affordable catastrophic coverage.] (c) The [commissioner by rule shall establish coverage requirements for the basic coverage benefit plan. Coverage under the] basic coverage benefit plan must [be designed to] provide basic hospital, medical, and surgical coverages. [Benefits under the plan are limited to basic care requirements for illness and injury.] (d) The [benefits] provisions of the benefit plan policies must include the following: (1) all required or applicable definitions; (2) a list of any exclusions or limitations to coverage; (3) a description of covered benefits and services [required under the plan]; and (4) the deductible and coinsurance options that are required or permitted under the plan. (e) The commissioner shall establish deductibles and coinsurance requirements for the basic coverage benefit plan and the catastrophic care benefit plan at levels that provide access to affordable basic and catastrophic coverage. SECTION 2. This Act takes effect September 1, 2003, and applies only to an insurance policy, certificate, evidence of coverage, plan document, or health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2004. An insurance policy, certificate, evidence of coverage, plan document, or health benefit plan that is delivered, issued for delivery, or renewed before January 1, 2004, is governed by the law as it existed immediately before the effective date of this Act, and the former law is continued in effect for that purpose.