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Amend CSSB 1007 (Senate committee report) by inserting the
following appropriately numbered SECTIONS and renumbering
subsequent SECTIONS of the bill appropriately:
SECTION ____. Subchaper B, Chapter 541, Insurance Code, is
amended by adding Section 541.062 to read as follows:
Sec. 541.062. BAD FAITH CANCELLATION OR RESCISSION. It is
an unfair method of competition or an unfair or deceptive act or
practice for a health benefit plan issuer to:
(1) set cancellation or rescission goals, quotas, or
targets;
(2) pay compensation of any kind, including a bonus or
award, that varies according to the number of cancellations or
rescissions;
(3) set, as a condition of employment, a number or
volume of cancellations or rescissions to be achieved; or
(4) set a performance standard, for employees or by
contract with another entity, based on the number or volume of
cancellations or rescissions.
SECTION ____. Chapter 1202, Insurance Code, is amended by
adding Subchapter C to read as follows:
SUBCHAPTER C. NOTICE REQUIRED FOR CERTAIN CANCELLATION OR
RESCISSION DECISIONS
Sec. 1202.101. APPLICABILITY. (a) This subchapter
applies only to a health benefit plan, including a small or large
employer health benefit plan written under Chapter 1501, 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 company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a Lloyd's plan operating under Chapter 941;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) This subchapter does not apply to:
(1) a health benefit plan that provides coverage:
(A) only for a specified disease or for another
limited benefit other than an accident policy;
(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;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance;
(F) only for dental or vision care;
(G) only for hospital expenses; or
(H) only for indemnity for hospital confinement;
(2) a Medicare suplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
as amended;
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(5) a long-term care insurance 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 described by
Subsection (a).
Sec. 1202.102. NOTICE OF INTENT TO CANCEL OR RESCIND. (a) A
health benefit plan issuer may not cancel or rescind a health
benefit plan on the basis of a misrepresentation or a preexisting
condition without first notifying an affected individual in writing
sixty days before the issuer's intent to cancel or rescind the
health benefit plan.
(b) The notice required under Subsection (a) must include,
as applicable:
(1) the principal reasons for the decision to cancel
or rescind the health benefit plan;
(2) the clinical basis for a determination that a
preexisting condition exists;
(3) a description of any general screening criteria
used to evaluate issued health benefit plans and determine
eligibility for a decision to cancel or rescind;
(4) notice that the individual may file a complaint
with the department if the individual believes the cancellation or
rescission is inappropriate.
Sec. 1202.103. RULES. The commissioner shall adopt rules
to implement and administer this subchapter.