79R494 AJA-D

By:  Nelson                                                       S.B. No. 51 



A BILL TO BE ENTITLED

AN ACT

relating to eligibility for coverage of, and payment of premiums 
for, certain individuals covered under certain group health benefit 
plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter A, Chapter 1301, Insurance Code, as 
effective April 1, 2005, is amended by adding Section 1301.0061 to 
read as follows:
	Sec. 1301.0061.  TERMS OF ENROLLEE ELIGIBILITY.  A contract 
between an insurer and a group policyholder under a preferred 
provider benefit plan must provide that:
		(1)  the group policyholder will provide the insurer 
with a copy of an insured's certificate of creditable coverage, if 
applicable, at the time the insured becomes eligible for coverage 
under the policy;
		(2)  the group policyholder is liable for an individual 
insured's premiums for the month in which the policyholder notifies 
the insurer that the individual is no longer part of the group 
eligible for coverage under the policy; and
		(3)  the individual remains covered under the policy 
during that month.
	SECTION 2.  Subchapter F, Chapter 843, Insurance Code, is 
amended by adding Section 843.210 to read as follows:
	Sec. 843.210.  TERMS OF ENROLLEE ELIGIBILITY.  A contract 
between a health maintenance organization and a group contract 
holder must provide that:
		(1)  the group contract holder will provide the health 
maintenance organization with a copy of an enrollee's certificate 
of creditable coverage, if applicable, at the time the enrollee 
becomes eligible for coverage under the contract;
		(2)  the group contract holder is liable for an 
enrollee's premiums for the month in which the contract holder 
notifies the health maintenance organization that the enrollee is 
no longer part of the group eligible for coverage by the contract; 
and
		(3)  the enrollee remains covered by the contract 
during that month. 
	SECTION 3.  The change in law made by this Act applies only 
to a contract between an insurer or health maintenance organization 
and a group policy or contract holder that is entered into or 
renewed on or after January 1, 2006.  A contract entered into or 
renewed before January 1, 2006, is governed by the law in effect 
immediately 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.