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A BILL TO BE ENTITLED
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AN ACT
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relating to the regulation of health benefit plan issuers and |
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dissemination of information to patients, physicians, and other |
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providers. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1274, Insurance Code, Section 1274.002 |
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is amended to read as follows: |
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Sec. 1274.002. TRANSMISSION OF ENROLLEE ELIGIBILITY AND |
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PAYMENT STATUS. (a) Each health benefit plan issuer shall, via |
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smart card technology or other similar technology or upon the |
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treating or participating provider's submission of the patient's |
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name, relationship to the primary enrollee, and birth date, make |
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available [telephonically,] electronically[, or by an Internet
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website portal] to each [participating] provider information |
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[maintained in the ordinary course of business and] sufficient for |
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the provider to determine at the time of the enrollee's visit |
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information concerning: |
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(1) the enrollee, including: |
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(A) the enrollee's identification number |
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assigned by the health benefit plan issuer; |
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(B) the name of the enrollee and all covered |
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dependents, if appropriate; |
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(C) the birth date of the enrollee and the birth |
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dates of all covered dependents, if appropriate; |
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(D) the gender of the enrollee and the gender of |
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each covered dependent, if appropriate; and |
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(E) the current enrollment and eligibility |
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status of the enrollee under the health benefit plan; |
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(2) the enrollee's benefits, including: |
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(A) whether a specific type or category of |
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service is a covered benefit; and |
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(B) excluded benefits or limitations, both group |
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and individual; and |
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(3) the enrollee's financial information, including: |
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(A) copayment requirements, if any; and |
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(B) the unmet amount of the enrollee's deductible |
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or enrollee financial responsibility. |
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(b) Information required to be made available under this |
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section may be made available only to a participating provider who |
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is authorized under state and federal law to receive personally |
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identifiable information on an enrollee or dependent. |
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SECTION 2. This Act takes effect September 1, 2007. |