79R2717 KCR-D

By:  Seaman                                                       H.B. No. 888



A BILL TO BE ENTITLED

AN ACT

relating to the reporting of claims information under certain 
health benefit plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter C, Chapter 1501, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 1501.112 to 
read as follows:
	Sec. 1501.112.  REPORTING OF CLAIMS INFORMATION.  (a)  In 
this section, "plan sponsor" means:
		(1)  a small or large employer that offers or provides 
employees participation in a small or large employer health benefit 
plan; or
		(2)  a person who administers, sponsors, or serves as 
trustee for a small or large employer described by Subdivision (1).
	(b)  Not later than the 30th day after the date a health 
benefit plan issuer receives a written request for a written report 
of claim information from a plan sponsor, the health benefit plan 
issuer shall provide the plan sponsor the requested report.
	(c)  As permitted by federal law, a report of claim 
information provided under Subsection (b) must contain all 
information available to the health benefit plan issuer that is 
responsive to the request made under Subsection (b), including 
nonpublic personal health information, for the 36-month period 
preceding the date of the request or for the entire period of 
coverage, whichever period is shorter.  A report provided under 
this subsection must include:
		(1)  aggregate paid claims experience by month, 
including claims experience for medical, dental, and pharmacy 
benefits;
		(2)  total premium paid by month;                                      
		(3)  total dollar amount of pending claims;                            
		(4)  total number of covered employees on a monthly 
basis, by coverage tier based on dependent participation; and
		(5)  a separate description of any large or 
catastrophic claim exceeding $10,000, including the amounts paid, 
dates of service, applicable diagnosis codes, and other 
underwriting information that relates to the catastrophic claim and 
is necessary to the settlement or payment of the claim.
	(d)  In the case of a request made under Subsection (b) after 
the date of termination of coverage, as permitted by federal law, 
the report must contain all information available to the health 
benefit plan issuer that is responsive to the request, including 
nonpublic personal health information, and including the 
information described by Subsections (c)(1)-(5), for the 36-month 
period preceding the date of termination of coverage or for the 
entire policy period, whichever period is shorter.
	(e)  A plan sponsor may use information in a written report 
of claim information provided under this section only as necessary 
to perform a function described by Section 602.053.
	(f)  Not later than the 60th day after the date of 
termination of coverage under a health benefit plan and as 
permitted by federal law, a health benefit plan issuer shall 
provide a plan sponsor who makes a request under Subsection (b) 
before the date of termination of coverage a supplemental written 
report of the information described by Subsections (c)(1)-(5), 
including nonpublic personal health information, to update the 
report of claim information with information that was not included 
in the original report provided under Subsection (b).
	(g)  A plan sponsor must request a report under Subsection 
(b) before or on the third anniversary of the date of termination of 
coverage under a health benefit plan issued by the health benefit 
plan issuer.
	(h)  The commissioner, after notice and hearing:                        
		(1)  shall impose sanctions described by Subchapter B, 
Chapter 82; and
		(2)  may issue an emergency cease and desist order 
under Chapter 83. 
	SECTION 2.  Section 1501.614, Insurance Code, as effective 
April 1, 2005, is repealed.
	SECTION 3.  The change in law made by this Act applies only 
to a report of claim information that is requested on or after the 
effective date of this Act.  A report of claim information that is 
requested before the effective date of this Act is governed by the 
law as it existed before the effective date of this Act, and that 
law is continued in effect for that purpose.
	SECTION 4.  This Act takes effect September 1, 2005.