78R6681 AJA-D

By:  Brown of Kaufman                                             H.B. No. 1291



A BILL TO BE ENTITLED

AN ACT

relating to the provision of loss experience information to certain 
group health benefit plan policy and contract holders.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is 
amended by adding Article 21.67 to read as follows:
	Art. 21.67.  PROVISION OF LOSS HISTORY TO CERTAIN HEALTH 
BENEFIT PLAN POLICY OR CONTRACT HOLDERS
	Sec. 1.  DEFINITION.  (a)  In this article, "group health 
benefit plan" means a group plan that provides benefits for medical 
or surgical expenses incurred as a result of a health condition, 
accident, or sickness, including a group, blanket, or franchise 
insurance policy or insurance agreement, a group hospital service 
contract, or a group evidence of coverage or similar coverage 
document that is offered by:
		(1)  an insurance company;                                             
		(2)  a group hospital service corporation operating 
under Chapter 842 of this code;
		(3)  a fraternal benefit society operating under 
Chapter 885 of this code;
		(4)  a stipulated premium insurance company operating 
under Chapter 884 of this code;
		(5)  an exchange operating under Chapter 942 of this 
code;           
		(6)  a Lloyds' plan operating under Chapter 941 of this 
code;        
		(7)  a health maintenance organization operating under 
Chapter 843 of this code;
		(8)  a multiple employer welfare arrangement that holds 
a certificate of authority under Chapter 846 of this code; or
		(9)  an approved nonprofit health corporation that 
holds a certificate of authority under Chapter 844 of this code.
	(b)  The term includes a small employer health benefit plan 
written under Chapter 26 of this code.
	(c)  The term does not include:                                         
		(1)  a plan that provides coverage:                                    
			(A)  only for a specified disease or other limited 
benefit;         
			(B)  only for accidental death or dismemberment;                      
			(C)  for wages or payments in lieu of wages for a 
period during which an employee is absent from work because of 
sickness or injury;
			(D)  as a supplement to a liability insurance 
policy;               
			(E)  only for dental or vision care; or                               
			(F)  only for indemnity for hospital confinement;                     
		(2)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 
as amended;
		(3)  a workers' compensation insurance policy;                         
		(4)  medical payment insurance coverage provided under 
a motor vehicle insurance policy;
		(5)  a credit insurance policy; or                                     
		(6)  a long-term care policy, including a nursing home 
fixed indemnity policy, unless the commissioner determines that the 
policy provides benefit coverage so comprehensive that the policy 
is a group health benefit plan as described by Subsection (a).
	Sec. 2.  PROVISION OF LOSS HISTORY.  (a)  Not later than the 
90th day before the expiration date of a group health benefit plan 
that covers a group of 10 or more individuals, the issuer of the 
plan shall provide the policy or contract holder a written 
statement, in the format prescribed by the commissioner by rule, of 
the premiums and claims paid under the plan for each month before 
the statement is prepared and any additional experience prescribed 
by the commissioner by rule.  The commissioner may not require for 
the purposes of this article that an issuer of a group health 
benefit plan provide nonpublic personal health information as 
defined by Article 28B.01 of this code.
	(b)  Not later than the 60th day after the expiration date of 
a group health benefit plan that covers a group of 10 or more 
individuals, the issuer of the plan shall provide the policy or 
contract holder a written statement of the information described by 
Subsection (a) of this section for each month not included in the 
statement required by Subsection (a).
	SECTION 2.  This Act applies only to a health benefit plan 
policy or contract that expires on or after January 1, 2004.  A 
policy or contract that expires before that date is governed by the 
law in effect immediately before the effective date of this Act, and 
that law is continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2003.