80R2348 PB-D

By: Woolley H.B. No. 522

A BILL TO BE ENTITLED

AN ACT

relating to 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. IDENTIFICATION CARD REQUIREMENTS FOR CERTAIN HEALTH BENEFIT PLAN COVERAGE

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

Sec. 1215.002. APPLICABILITY OF CHAPTER. (a) 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.

(b) Notwithstanding Section 172.014, Local Government Code, or any other law, this chapter applies to health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code.

(c) Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, this chapter applies to:

(1) a basic coverage plan under Chapter 1551;

(2) a basic plan under Chapter 1575;

(3) a primary care coverage plan under Chapter 1579; and

(4) basic coverage under Chapter 1601.

(d) Notwithstanding any other law, this chapter applies to a standard health benefit plan provided under Chapter 1507.

Sec. 1215.003. EXCEPTION. This chapter does not apply to:

(1) a plan that provides coverage:

(A) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;

(B) as a supplement to a liability insurance policy;

(C) for credit insurance; or

(D) only for indemnity for hospital confinement;

(2) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);

(3) a workers' compensation insurance policy;

(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 health benefit plan as described by Section 1215.002.

Sec. 1215.004. IDENTIFICATION CARD REQUIREMENTS. (a) The issuer of a health benefit plan described by Section 1215.002, including a dental benefits plan, vision benefits plan, or pharmacy benefits plan, shall issue an identification card or similar document to each enrollee. The card or document must include, at a minimum:

(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; and

(5) a telephone number or electronic address for authorizations.

(b) The information required under Subsection (a) 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.

(c) The identification card must contain the required information embedded in the card and accessible through magnetic strip or smart card technology.

(d) The commissioner by rule may change the form of the electronic technology required under Subsection (c) as necessary to conform to changes in that technology.

Sec. 1215.005. IMPLEMENTATION PROGRAM. (a) Each issuer of a health benefit plan shall comply with Section 1215.004 not later than March 1, 2008.

(b) To ensure timely compliance with Section 1215.004, an issuer of a health benefit plan shall submit its implementation program to the department, in the form prescribed by the commissioner, not later than January 1, 2008.

(c) This section expires August 31, 2008.

SECTION 2. Section 843.209, Insurance Code, is amended to read as follows:

Sec. 843.209. IDENTIFICATION CARD. (a) An identification card or other similar document issued by a health maintenance organization to an enrollee must:

(1) indicate that the health maintenance organization is regulated under this code and subject to the provisions of Subchapter J; and

(2) display:

(A) the first date on which the enrollee became enrolled; or

(B) a toll-free number a physician or provider may use to obtain that date.

(b) The identification card or other similar document must comply with the requirements adopted under Chapter 1215.

SECTION 3. Section 1301.162, Insurance Code, is amended to read as follows:

Sec. 1301.162. IDENTIFICATION CARD. (a) An identification card or other similar document issued by an insurer regulated by this code and subject to this chapter to an individual insured must display:

(1) the first date on which the individual became insured under the plan; or

(2) a toll-free number a physician or health care provider may use to obtain that date.

(b) The identification card or other similar document must comply with the requirements adopted under Chapter 1215.

SECTION 4. Section 1369.153, Insurance Code, is amended by adding Subsection (a-1) and amending Subsection (b) to read as follows:

(a-1) The identification card must comply with the requirements adopted under Chapter 1215.

(b) This section does not require a health benefit plan issuer that administers its own pharmacy benefits to issue an identification card separate from any identification card issued to an enrollee to evidence coverage under the plan if the identification card issued to evidence coverage contains the information required by Subsection (a) and complies with the requirements adopted under Chapter 1215.

SECTION 5. Section 1504.055(a), Insurance Code, is amended to read as follows:

(a) A health benefit plan issuer that provides health coverage to a child through a covered parent of the child shall:

(1) provide to each custodial parent of the child or to an adult child documents and other information necessary for the child to obtain benefits under the coverage, including:

(A) the name of the issuer;

(B) the number of the policy or evidence of coverage;

(C) a copy of the policy or evidence of coverage and schedule of benefits;

(D) an identification [a health coverage membership] card that complies with the requirements adopted under Chapter 1215;

(E) claim forms; and

(F) any other document or information necessary to submit a claim in accordance with the issuer's policies and procedures;

(2) permit a custodial parent, health care provider, state agency that has been assigned medical support rights, or adult child to submit claims for covered services without the approval of the covered parent; and

(3) make payments on covered claims submitted in accordance with this subsection directly to a custodial parent, health care provider, adult child, or state agency making a claim.

SECTION 6. Section 1551.060, Insurance Code, is amended by adding Subsection (c) to read as follows:

(c) The card must comply with the requirements adopted under Chapter 1215.

SECTION 7. Section 4151.152, Insurance Code, is amended by adding Subsection (c) to read as follows:

(c) The identification card must comply with the requirements adopted under Chapter 1215.

SECTION 8. This Act takes effect September 1, 2007.