By:  Hochberg                                                     H.B. No. 2813



A BILL TO BE ENTITLED

AN ACT

relating to eligibility for coverage by the Texas Health Insurance 
Risk Pool.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 1506.151, Insurance Code, is amended by 
amending Subsection (a) to read as follows:
	(a)  The pool shall offer coverage:                                            
		(1)  consistent with major medical expense coverage to 
each eligible individual who is not eligible for Medicare; and
		(2)  to each individual eligible for pool coverage by 
satisfying §1506.152(a)(3)(G), coverage consistent with specified 
disease coverage for each condition excluded by rider in the 
individual's coverage.
	SECTION 2.  Section 1506.152, Subsection (a)(3), Insurance 
Code, is amended to read as follows:
		(3)  has been a legally domiciled resident of this 
state for the preceding 30 days, is a citizen of the United States 
or has been a permanent resident of the United States for at least 
three continuous years, and provides to the pool:
			(A)  a notice of rejection of, or refusal to 
issue, substantially similar individual health benefit plan 
coverage from a health benefit plan issuer, other than an insurer 
that offers only stop-loss, excess loss, or reinsurance coverage, 
if the rejection or refusal was for health reasons;
			(B)  certification from an agent or salaried 
representative of a health benefit plan issuer that states that the 
agent or salaried representative cannot obtain substantially 
similar individual coverage for the individual from any health 
benefit plan issuer that the agent or salaried representative 
represents because, under the underwriting guidelines of the health 
benefit plan issuer, the individual will be denied coverage as a 
result of a medical condition of the individual;
			(C)  an offer to issue substantially similar 
individual coverage only with conditional riders;
			(D)  a rate for continuation of coverage under 
Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 
U.S.C. Section 1161 et seq.), as amended (COBRA) available to the 
individual that exceeds the pool rate;
			(E)  proof that continuation of coverage under 
COBRA available to the individual would not provide coverage 
substantially similar to pool coverage;
			(F)  a notice of eligibility for continuation of 
coverage for COBRA that shows that the individual's right to elect 
to continue coverage is no longer valid;
			(G)  individual coverage excluding one or more 
conditions by rider; 
			(H)  a notice of refusal by a health benefit plan 
issuer to issue substantially similar individual coverage except at 
a rate exceeding the pool rate;  or
			(I) [(E)]  a diagnosis of the individual with one 
of the medical or health conditions on the list adopted under 
Section 1506.154.
	SECTION 3.  Section 1506.153, paragraph (2), Insurance Code, 
is amended to read as follows:
		(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), (D), (E) or (F);  or
			(C)  individual coverage conditioned by a 
limitation described by Section 1506.152(a)(3)(C), (G), or (H) 
[(D)];
	SECTION 4.  This Act takes effect September 1, 2005.