By:  Farabee                                                      H.B. No. 1800



A BILL TO BE ENTITLED

AN ACT

relating to health maintenance organizations.                                 
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 9(a), Texas Health Maintenance 
Organization Act (Article 20A.09, Vernon's Texas Insurance Code), 
is amended to read as follows:
	(a)  Every enrollee residing in this state is entitled to 
evidence of coverage under a health care plan.  If the enrollee 
obtains coverage under a health care plan through an insurance 
policy or a contract issued by a group hospital service 
corporation, whether by option or otherwise, the insurer or the 
group hospital service corporation shall issue the evidence of 
coverage.  Otherwise, the health maintenance organization shall 
issue the evidence of coverage.  By agreement between the insurer, 
group hospital service corporation, or health maintenance 
organization and the subscriber, or the person entitled to receive 
the policy, contract, or evidence of coverage, the evidence of 
coverage required by this section may be delivered electronically.
	SECTION 2.  Section 843.201, Insurance Code, is amended to 
read as follows:  
	Sec. 843.201.  DISCLOSURE OF INFORMATION ABOUT HEALTH CARE 
PLAN TERMS.  (a)  A health maintenance organization shall provide an 
accurate written or electronic description of health care plan 
terms, including restrictions or limitations related to a limited 
provider network or delegated network within a health care plan, to 
allow a current or prospective group contract holder or current or 
prospective enrollee to make comparisons and informed decisions 
before selecting among health care plans.  The written or 
electronic description must:
		(1)  be in readable and understandable format 
prescribed by the commissioner; and
		(2)  include a current list of physicians and 
providers, including a delineation of any limited provider network 
or delegated network.
	(b)  A health maintenance organization may satisfy the 
requirement imposed under Subsection (a) through the member 
handbook provided under Section 843.205 if:
		(1)  the handbook's contents are substantially similar 
to and provide the same level of disclosure as the written or 
electronic description prescribed by the commissioner; and
		(2)  the current list of physicians and providers is 
also provided.         
	SECTION 3.  This Act takes effect September 1, 2003.