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.