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A BILL TO BE ENTITLED
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AN ACT
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relating to the use of certain insurance policy forms in connection |
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with a preferred provider benefit plan. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1701.001, Insurance Code, is amended to |
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read as follows: |
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Sec. 1701.001. DEFINITIONS [DEFINITION]. In this chapter: |
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(1) "Nonparticipating physician or health care |
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provider" means a physician or other health care provider who is not |
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a party under a contract to provide health care services through a |
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provider network. |
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(2) "Provider network" means a health benefit plan |
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issued by a preferred provider benefit plan issuer: |
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(A) under which health care services are provided |
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to enrollees in the plan through contracts with physicians and |
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other health care providers; and |
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(B) that requires those enrollees to use |
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physicians and other health care providers participating in the |
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plan and procedures covered by the plan for a different level of |
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coverage. |
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(3) "Use" [, "use"] includes issue and deliver. |
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SECTION 2. Section 1701.055, Insurance Code, is amended by |
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adding Subsections (f) and (g) to read as follows: |
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(f) Notwithstanding Section 1301.003, the commissioner |
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shall find a policy form filed by an insurer for a preferred |
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provider benefit plan to be unjust and deceptive if the form does |
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not contain a provision that computes the enrollee's coinsurance |
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for health care services otherwise available under the plan that |
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are provided by nonparticipating physicians or health care |
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providers based on the billed charge of the nonparticipating |
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physician or health care provider. |
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(g) If the commissioner determines that use of a form that |
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does not comply with Subsection (f) poses an imminent threat to the |
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health, safety, or welfare of the residents of this state, the |
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commissioner may by order withdraw approval of the form under this |
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section without notice and hearing. The insurer shall cease using |
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the form immediately on receipt of notice of the order. |
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SECTION 3. 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, 2009. |