Amend CSSB 809 as follows:
(1) on page 3, line 27, strike "or"
(2) between page 3, line 27 and page 4, line 28 insert the
following:
(E) evidence that the individual is covered by
substantially similar individual coverage that excludes one or more
conditions by rider; or
(3) Insert the following appropriately numbered section and
renumber the remaining sections accordingly:
SECTION . Section 1506.153, Insurance Code, is amended to
read as follows:
Sec. 1506.153. INELIGIBILITY FOR COVERAGE. Notwithstanding
Sections 1506.152(a)-(d), an individual is not eligible for
coverage from the pool if:
(1) on the date pool coverage is to take effect, the
individual has health benefit plan coverage from a health benefit
plan issuer or health benefit arrangement in effect, except as
provided by Section 1506.152(a)(3)(E);
(2) at the time the individual applies to the pool, the
individual is eligible for other health care benefits, including
benefits from the continuation of coverage under Title X,
Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C.
Section 1161 et seq.), as amended (COBRA), other than:
(A) coverage, including COBRA or other
continuation coverage or conversion coverage, maintained for any
preexisting condition waiting period under a pool policy;
(B) employer group coverage conditioned by a
limitation of the kind described by Section 1506.152(a)(3)(A) or
(C); or
(C) individual coverage conditioned by a
limitation described by Section 1506.152(a)(3)(C), [or] (D), or
(E);
(3) within 12 months before the date the individual
applies to the pool, the individual terminated coverage in the
pool, unless the individual demonstrates a good faith reason for
the termination;
(4) the individual is confined in a county jail or
imprisoned in a state or federal prison;
(5) any of the individual's premiums are paid for or
reimbursed under a government-sponsored program or by a government
agency or health care provider, other than as an otherwise
qualifying full-time employee of a government agency or health care
provider or as a dependent of such an employee;
(6) the individual's prior coverage with the pool was
terminated:
(A) during the 12-month period preceding the date
of application for nonpayment of premiums; or
(B) for fraud; or
(7) the individual is eligible for health benefit plan
coverage provided in connection with a policy, plan, or program
paid for or sponsored by an employer, even though the employer
coverage is declined.
SECTION . Section 1506.156, Insurance Code, is amended to
read as follows:
Sec. 1506.156. BENEFIT REDUCTION; CERTAIN COVERAGES
SECONDARY. (a) The pool shall reduce benefits otherwise payable
under pool coverage by:
(1) the total amount paid or payable through any other
health benefit plan or health benefit arrangement; and
(2) the total amount of hospital or medical expense
benefits paid or payable under:
(A) workers' compensation coverage;
(B) automobile insurance, regardless of whether
provided on the basis of fault or no fault; or
(C) a state or federal law or program.
(b) Pool coverage provided under Section 1506.152(a)(3)(E)
is secondary to the individual coverage described by that paragraph
for any period during which that individual coverage is in effect.