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.