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By: Nelson S.B. No. 53
A BILL TO BE ENTITLED
AN ACT
relating to the use of genetic testing information by insurers.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 546.002, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.002. APPLICABILITY OF CHAPTER. This chapter
applies only to a [group] health benefit plan that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including:
(A) an individual, [a] group, blanket, or
franchise insurance policy or insurance agreement, a group hospital
service contract, or an individual or [a] group evidence of
coverage that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation
operating under Chapter 842;
(iii) a fraternal benefit society operating
under Chapter 885;
(iv) a stipulated premium company operating
under Chapter 884; or
(v) a health maintenance organization
operating under Chapter 843; and
(B) to the extent permitted by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.), a [group] health benefit plan that is offered by:
(i) a multiple employer welfare arrangement
as defined by Section 3 of that Act;
(ii) another entity not authorized under
this code or another insurance law of this state that directly
contracts for health care services on a risk-sharing basis,
including a capitation basis; or
(iii) another analogous benefit
arrangement; or
(2) is offered by an approved nonprofit health
corporation that holds a certificate of authority under Chapter
844.
SECTION 2. Section 546.003, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.003. EXCEPTIONS. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury; or
(D) as a supplement to liability insurance;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(3) workers' compensation insurance coverage;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(5) a long-term care policy, including a nursing home
fixed indemnity policy, unless the commissioner determines that the
policy provides benefit coverage so comprehensive that the policy
is a [group] health benefit plan as described by Section 546.002.
SECTION 3. Section 546.051, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.051. CERTAIN TESTING PERMITTED; INDUCEMENT
PROHIBITED. (a) A [group] health benefit plan issuer that
requests an applicant for coverage under the plan to submit to a
genetic test in connection with the application for coverage for a
purpose not prohibited under Section 546.052 must:
(1) notify the applicant that the test is required;
(2) disclose to the applicant the proposed use of the
test results; and
(3) obtain the applicant's written informed consent
before the test is administered.
(b) The applicant shall state in the consent form whether
the applicant elects to be informed of the test results. If the
applicant elects to be informed, the person or entity that performs
the test shall disclose the test results to the applicant and the
[group] health benefit plan issuer. The issuer shall ensure that:
(1) the applicant receives an interpretation of the
test results made by a qualified health care practitioner; and
(2) a physician or other health care practitioner
designated by the applicant receives a copy of the test results.
(c) A [group] health benefit plan issuer may not use the
results of a genetic test conducted in accordance with Subsection
(a) to induce the purchase of coverage under the plan.
SECTION 4. Section 546.052, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.052. IMPROPER USE OF TEST RESULTS; REFUSAL TO
SUBMIT TO TESTING. A [group] health benefit plan issuer may not
use genetic information or the refusal of an applicant to submit to
a genetic test to reject, deny, limit, cancel, refuse to renew,
increase the premiums for, or otherwise adversely affect
eligibility for or coverage under the plan.
SECTION 5. Section 546.053, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.053. TESTING RELATED TO PREGNANCY. (a) In this
section, "coerce" means to restrain or dominate a woman's free will
by actual or implied:
(1) force; or
(2) threat of rejecting, denying, limiting,
canceling, refusing to renew, or otherwise adversely affecting
eligibility for coverage under a [group] health benefit plan.
(b) A [group] health benefit plan issuer may not:
(1) require as a condition of coverage genetic testing
of a child in utero without the pregnant woman's consent; or
(2) use genetic information to coerce or compel a
pregnant woman to have an induced abortion.
SECTION 6. Subsection (a), Section 546.101, Insurance Code,
as effective April 1, 2005, is amended to read as follows:
(a) An individual who submits to a genetic test has the
right to know the results of the test. On the written request by the
individual, the [group] health benefit plan issuer or other entity
that performed the test shall disclose the test results to:
(1) the individual; or
(2) a physician designated by the individual.
SECTION 7. Subsection (c), Section 546.102, Insurance Code,
as effective April 1, 2005, is amended to read as follows:
(c) This section applies to a redisclosure of genetic
information by a secondary recipient of the information after
disclosure of the information by an initial recipient. Except as
provided by Section 546.103(b), a [group] health benefit plan
issuer may not redisclose genetic information unless the
redisclosure is consistent with the disclosures authorized by the
tested individual under an authorization executed under Section
546.104.
SECTION 8. Subsection (b), Section 546.103, Insurance Code,
as effective April 1, 2005, is amended to read as follows:
(b) A [group] health benefit plan issuer may redisclose
genetic information without an authorization under Section
546.104:
(1) for actuarial or research studies if:
(A) a tested individual could not be identified
in any actuarial or research report; and
(B) any materials that identify a tested
individual are returned or destroyed as soon as reasonably
practicable;
(2) to the department for the purpose of enforcing
this chapter; or
(3) for a purpose directly related to enabling a
business decision to be made about:
(A) purchasing, transferring, merging, or
selling all or part of an insurance business; or
(B) obtaining reinsurance affecting that
insurance business.
SECTION 9. Section 546.104, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.104. AUTHORIZED DISCLOSURE. An individual or an
individual's legal representative may authorize disclosure of
genetic information relating to the individual by an authorization
that:
(1) is written in plain language;
(2) is dated;
(3) contains a specific description of the information
to be disclosed;
(4) identifies or describes each person authorized to
disclose the genetic information to a [group] health benefit plan
issuer;
(5) identifies or describes the individuals or
entities to whom the disclosure or subsequent redisclosure of the
genetic information may be made;
(6) describes the specific purpose of the disclosure;
(7) is signed by the individual or legal
representative and, if the disclosure is made to claim proceeds of
an affected life insurance policy, the claimant; and
(8) advises the individual or legal representative
that the individual's authorized representative is entitled to
receive a copy of the authorization.
SECTION 10. Section 546.151, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.151. CEASE AND DESIST ORDER. (a) On a finding by
the commissioner that a [group] health benefit plan issuer is in
violation of this chapter, the commissioner may issue a cease and
desist order in the manner provided by Chapter 83.
(b) If a [group] health benefit plan issuer refuses or fails
to comply with a cease and desist order issued under this section,
the commissioner may, in the manner provided by this code and other
insurance laws of this state, revoke or suspend the issuer's
certificate of authority or other authorization to operate a
[group] health benefit plan in this state.
SECTION 11. Section 546.152, Insurance Code, as effective
April 1, 2005, is amended to read as follows:
Sec. 546.152. ADMINISTRATIVE PENALTY. A [group] health
benefit plan issuer that operates a plan in violation of this
chapter is subject to an administrative penalty as provided by
Chapter 84.
SECTION 12. This Act applies only to a health benefit plan
delivered, issued for delivery, or renewed on or after January 1,
2006. A health benefit plan delivered, issued for delivery, or
renewed before January 1, 2006, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 13. This Act takes effect September 1, 2005.