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AN ACT
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relating to coverage limitations in health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1201.154(b), Insurance Code, is amended |
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to read as follows: |
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(b) A preexisting condition provision in an individual |
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accident and health insurance policy may not apply to an |
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individual[:
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[(1)] who was continuously covered for an aggregate |
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period of 18 months by creditable coverage that was in effect up to |
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a date not more than 63 days before the effective date of the |
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individual coverage, excluding any waiting period [; and
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[(2) whose most recent creditable coverage was under:
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[(A) a group health plan;
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[(B) a governmental plan; or
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[(C) a church plan]. |
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SECTION 2. Section 1506.153, Insurance Code, as amended by |
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Chapters 728 and 824, Acts of the 79th Legislature, Regular |
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Session, 2005, is amended to read as follows: |
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Sec. 1506.153. INELIGIBILITY FOR COVERAGE. (a) |
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Notwithstanding Sections 1506.152(a)-(c) [1506.152(a)-(d)], an |
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individual is not eligible for coverage from the pool if: |
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(1) on the date pool coverage is to take effect, the |
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individual has health benefit plan coverage from a health benefit |
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plan issuer or health benefit arrangement in effect, except as |
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provided by Section 1506.152(a)(3)(E); |
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(2) at the time the individual applies to the pool, |
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except as provided in Subsection (b), the individual is eligible |
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for other health care benefits, including benefits from the |
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continuation of coverage under Title X, Consolidated Omnibus Budget |
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Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.), as |
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amended (COBRA), other than: |
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(A) coverage, including COBRA or other |
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continuation coverage or conversion coverage, maintained for any |
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preexisting condition waiting period under a pool policy; |
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(B) employer group coverage conditioned by a |
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limitation of the kind described by Section 1506.152(a)(3)(A) or |
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(C); or |
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(C) individual coverage conditioned by a |
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limitation described by Section 1506.152(a)(3)(C) or (D); |
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(3) within 12 months before the date the individual |
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applies to the pool, the individual terminated coverage in the |
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pool, unless the individual demonstrates a good faith reason for |
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the termination; |
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(4) the individual is confined in a county jail or |
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imprisoned in a state or federal prison; |
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(5) any of the individual's premiums are paid for or |
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reimbursed under a government-sponsored program or by a government |
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agency or health care provider, other than as an otherwise |
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qualifying full-time employee of a government agency or health care |
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provider or as a dependent of such an employee; |
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(6) the individual's prior coverage with the pool was |
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terminated: |
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(A) during the 12-month period preceding the date |
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of application for nonpayment of premiums; or |
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(B) for fraud; or |
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(7) the individual is eligible for health benefit plan |
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coverage provided in connection with a policy, plan, or program |
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paid for or sponsored by an employer, even though the employer |
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coverage is declined. This subdivision does not apply to an |
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individual who is a part-time employee eligible to participate in |
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an employer plan that provides health benefit coverage: |
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(A) that is more limited or restricted than |
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coverage with the pool; and |
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(B) for which there is no employer contribution |
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to the premium, either directly or indirectly. |
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(b) An individual eligible for benefits from the |
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continuation of coverage under Title X, Consolidated Omnibus Budget |
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Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.), as |
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amended (COBRA), who did not elect continuation of coverage during |
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the election period, or whose elected continuation of coverage |
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lapsed or was cancelled without reinstatement, is eligible for pool |
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coverage. Eligibility under this subsection is subject to a |
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180-day exclusion of coverage under Section 1506.155(a-1). |
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SECTION 3. Section 1506.155, Insurance Code, is amended by |
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adding Subsection (a-1) to read as follows: |
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(a-1) Except as provided by Section 1506.056, pool coverage |
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for an individual eligible pursuant to Section 1506.153(b) excludes |
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charges or expenses incurred before the expiration of 180 days from |
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the effective date of coverage with regard to any condition for |
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which: |
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(1) the existence of symptoms would cause an |
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ordinarily prudent person to seek diagnosis, care, or treatment |
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within the six-month period preceding the effective date of |
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coverage; or |
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(2) medical advice, care, or treatment was recommended |
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or received during the six-month period preceding the effective |
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date of coverage. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2007. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I certify that H.B. No. 2548 was passed by the House on May 8, |
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2007, by the following vote: Yeas 146, Nays 0, 2 present, not |
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voting; and that the House concurred in Senate amendments to H.B. |
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No. 2548 on May 23, 2007, by the following vote: Yeas 147, Nays 0, |
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1 present, not voting. |
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______________________________ |
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Chief Clerk of the House |
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I certify that H.B. No. 2548 was passed by the Senate, with |
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amendments, on May 18, 2007, by the following vote: Yeas 30, Nays |
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0. |
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______________________________ |
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Secretary of the Senate |
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APPROVED: __________________ |
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Date |
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__________________ |
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Governor |