80R11125 PB-D

By: Woolley, Hartnett, et al. H.B. No. 522

Substitute the following for H.B. No. 522:

By: Woolley C.S.H.B. No. 522

A BILL TO BE ENTITLED

AN ACT

relating to adoption and operation of requirements regarding health benefit plan identification cards.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle A, Title 8, Insurance Code, is amended by adding Chapter 1215 to read as follows: CHAPTER 1215. HEALTH BENEFIT PLAN IDENTIFICATION CARDS

Sec. 1215.001. DEFINITION. In this chapter, "enrollee" means an individual who is insured by or enrolled in a health benefit plan.

Sec. 1215.002. APPLICABILITY OF CHAPTER. This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter 842;

(3) a fraternal benefit society operating under Chapter 885;

(4) a stipulated premium insurance company operating under Chapter 884;

(5) a reciprocal exchange operating under Chapter 942;

(6) a health maintenance organization operating under Chapter 843;

(7) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or

(8) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.

Sec. 1215.003. IMPLEMENTATION OF IDENTIFICATION CARD REQUIREMENTS. (a) The department shall establish and implement requirements for identification cards issued to enrollees in conjunction with health benefit plans.

(b) The commissioner shall designate a county in this state with a population of at least three million for initial participation in the identification card requirements program. Not later than September 1, 2008, the department shall implement the program in the county designated by the commissioner.

(c) Not later than September 1, 2010, the department shall implement the requirements on a statewide basis.

Sec. 1215.004. IDENTIFICATION CARD REQUIREMENTS. (a) The commissioner shall require the issuer of a health benefit plan that is offered in a county in which the identification card requirements are implemented to issue an identification card that complies with the requirements of this section to each enrollee in the plan. The card must include:

(1) the name of the issuer of the health benefit plan;

(2) the name of the administrator of the health benefit plan, if any;

(3) the name of the policyholder or group contract holder;

(4) the number of the policy, contract, or evidence of insurance;

(5) a telephone number or electronic address for authorizations; and

(6) the name of the payor under the health benefit plan.

(b) In addition to the information required under Subsection (a), the commissioner, by rule, shall require the use of technology as appropriate to ensure that the card may be used to provide accurate and current information, with proper protection of the security of the information, to each enrollee regarding:

(1) deductibles;

(2) the allowable or usual and customary amounts paid by the plan for out-of-network care;

(3) participation in the plan's network by a physician or health care provider;

(4) any financial responsibility on the part of the insured or enrollee for services provided through the plan;

(5) whether physicians and other health care providers participating in the plan's network are accepting new patients; and

(6) the availability of physicians and other health care providers participating in the plan's network at hospitals that participate in that network.

(c) The information required under Subsections (a) and (b) is in addition to any other information required under this title to be included on an identification card or other document issued in conjunction with a health benefit plan.

Sec. 1215.005. RULES. (a) The commissioner shall adopt rules in the manner prescribed by Subchapter A, Chapter 36, as necessary to implement this chapter.

(b) The commissioner, by rule:

(1) shall:

(A) designate the type of technology to be used to provide the information required on an identification card described under Section 1215.004, which may include magnetic strip technology, smart card technology, biometric technology, or any other technology determined appropriate by the department; and

(B) protect the confidentiality and accuracy of the information described by Sections 1215.004(a)-(b); and

(2) may authorize changes in the form of the technology designated under Subdivision (1)(A) as necessary to conform to changes in that technology.

Sec. 1215.006. INSURER COMPLIANCE. (a) Each issuer of a health benefit plan that offers a health benefit plan in a county designated by the commissioner under Section 1215.003(b) for initial participation in the identification card requirements program shall comply with this chapter and rules adopted under this chapter not later than September 1, 2008.

(b) Each issuer of a health benefit plan that offers a health benefit plan in this state other than a plan described by Subsection (a) shall comply with this chapter and rules adopted under this chapter not later than September 1, 2010.

(c) To ensure timely compliance with the requirements of this chapter, the commissioner may require the issuer of a health benefit plan to submit its procedures for implementation of the requirements to the department in the form prescribed by the commissioner.

SECTION 2. This Act takes effect September 1, 2007.