2003S0106-1 01/21/03
By: Averitt S.B. No. 240
A BILL TO BE ENTITLED
AN ACT
relating to the enrollment of certain children and recipients of
medical assistance in group health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 62.059, Health and Safety Code, is
amended to read as follows:
Sec. 62.059. HEALTH INSURANCE PREMIUM ASSISTANCE [PAYMENT
REIMBURSEMENT] PROGRAM FOR CHILDREN ELIGIBLE FOR CHILD HEALTH PLAN.
(a) In this section, "group health benefit plan" has the meaning
assigned by Article 21.52K, Insurance Code.
(b) The [Under the direction of the] commission[, the Texas
Department of Health] shall identify children, otherwise eligible
to enroll in the state child health plan under this chapter, who are
eligible to enroll in a group health benefit plan.
(c) For a child identified under Subsection (b), the
commission [department] shall determine whether it is
cost-effective to enroll the child in the group health benefit plan
under this section. The commission may determine
cost-effectiveness on an aggregate basis for the premium assistance
program as a whole.
(d) If the commission [department] determines that it is
cost-effective to enroll the child in the group health benefit
plan, the commission [department] shall:
(1) inform [require] the child and the child's parent
or guardian of the availability of the premium assistance program
under this section [to apply to enroll in the group health benefit
plan as a condition for eligibility under this chapter]; [and]
(2) offer, as an optional alternative to enrollment in
the commission's state child health plan benefit program, a premium
assistance payment to assist with the employee's or member's share
of the required premiums for the group health benefit plan that is
available to the child; and
(3) provide written notice to the issuer of the group
health benefit plan in accordance with Article 21.52K, Insurance
Code.
(e) The commission [department] shall determine the amount
of the premium assistance [provide for] payment. The premium
assistance payment shall be paid only for the reimbursement of the
employee's or member's share of required premiums for coverage of a
child enrolled in the group health benefit plan.
(f) The premium assistance payment [In addition to any
amount] paid under Subsection (e)[, the department] may provide
assistance for the payment of a group health benefit plan premium
that includes [for] the child's parent or other individuals [for an
individual] who are members [is a member] of the child's family [if:
[(1) the child is not eligible to be enrolled in the
group health benefit plan unless the other individual is also
enrolled in the plan; and
[(2) the department determines it to be
cost-effective].
(g) The commission [department] may not provide for the
payment of any deductible, copayment, coinsurance, or other
cost-sharing obligation for the child or another individual
enrolled in a group health benefit plan under Subsection (f).
(h) [Enrollment of a child in a group health benefit plan
under this chapter does not affect the child's eligibility for
benefits under this chapter, except that the program is the payor of
last resort for those benefits.
[(i)] The commission [department] may consolidate or
coordinate the administration of the program provided under this
section with a similar program provided under Section 32.0422,
Human Resources Code, for individuals eligible for medical
assistance under the state Medicaid program.
SECTION 2. Subsections (a), (b), and (f), Section 2,
Article 21.52K, Insurance Code, are amended to read as follows:
Sec. 2. (a) The issuer of a group health benefit plan, on
receipt of written notice from the [Texas Department of] Health and
Human Services Commission, or a designee of the commission [Texas
Department of Health] that states that an individual who is
otherwise eligible for enrollment in the plan is a recipient of
medical assistance under the state Medicaid program and is a
participant in the health insurance premium payment reimbursement
program for medical assistance recipients under Section 32.0422,
Human Resources Code, shall permit the individual to enroll in the
plan without regard to any enrollment period restriction.
(b) The issuer of a group health benefit plan, on receipt of
written notice from the [Texas Department of] Health and Human
Services Commission or a designee of the commission [Texas
Department of Health] that states that a child who is otherwise
eligible for enrollment in the plan is enrolled in the state child
health plan under Chapter 62, Health and Safety Code, and is a
participant in the health insurance premium assistance [payment
reimbursement] program under Section 62.059, Health and Safety
Code, provided for children eligible for the state child health
plan shall permit the child to enroll in the group health benefit
plan without regard to any enrollment period restriction.
(f) Notwithstanding any other requirement of the group
health benefit plan, the issuer of the plan shall permit an
individual who is enrolled in a group health benefit plan under
Subsection (b) of this section, and any family member of the
individual enrolled under Subsection (c) of this section, to
terminate enrollment in the plan not later than the 60th day after
the date on which the individual provides satisfactory proof to the
issuer that the child is no longer a participant in the health
insurance premium assistance [payment reimbursement] program under
Section 62.059, Health and Safety Code, provided for children
eligible for the state child health plan.
SECTION 3. (a) This Act takes effect September 1, 2003.
(b) The changes in law made by this Act apply only to a group
health benefit plan that is delivered, issued for delivery, or
renewed on or after September 1, 2003. A group health benefit plan
that is delivered, issued for delivery, or renewed before September
1, 2001, is governed by the law as it existed immediately before
that date, and that law is continued in effect for that purpose.