78R8161 T
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. Article 20A.09, Insurance Code, Subsection (a)
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 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 the 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, Subsections (a)
and (b) are 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 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 disclosure 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.