|
|
|
A BILL TO BE ENTITLED
|
|
AN ACT
|
|
relating to the availability and continuation of certain health |
|
benefit plan coverage. |
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
|
by adding Chapter 1202A to read as follows: |
|
CHAPTER 1202A. TEMPORARY EXTENSION OF ELECTION PERIOD FOR |
|
CONTINUATION OF CERTAIN COVERAGE |
|
Sec. 1202A.001. EXTENSION OF ELECTION PERIOD. (a) For the |
|
purposes of this section, an "extended election eligible |
|
individual" means an employee, member, dependent, or enrollee: |
|
(1) who became eligible for continuation coverage due |
|
to involuntary termination, other than involuntary termination for |
|
cause, under Subchapter F, Chapter 1251, or Subchapter G, Chapter |
|
1271, at any time during the period that begins on September 1, |
|
2008, and ends on February 16, 2009; |
|
(2) who did not elect such coverage or whose elected |
|
continuation coverage lapsed or was canceled without reinstatement |
|
for a reason other than exhaustion of the maximum period of |
|
continuation coverage allowable under law; and |
|
(3) whose involuntary termination on which the |
|
eligibility is based occurred during that same period. |
|
(b) Notwithstanding Section 1251.253 or 1271.301, an |
|
extended election eligible individual may elect continuation |
|
coverage under this section beginning on the effective date of this |
|
Act and ending on the 60th day after the date on which the |
|
notification required by Subsection (e) is provided to the |
|
individual. |
|
(c) The period of continuation coverage for an extended |
|
election eligible individual who elects continuation coverage |
|
begins with the first period of coverage beginning on or after the |
|
effective date of Senate Bill 1771, Acts of the 81st Legislature, |
|
Regular Session, 2009, and does not extend beyond the date the |
|
period of continuation coverage would have ended if the coverage |
|
had been elected during the election period required under the law |
|
as it existed before the effective date of Senate Bill 1771, Acts of |
|
the 81st Legislature, Regular Session, 2009. |
|
(d) With respect to an individual who elects continuation |
|
coverage under Subsection (b), the period beginning on the date the |
|
individual first became eligible for continuation coverage and |
|
ending on the first day of the 60-day election period described by |
|
Subsection (b) shall be disregarded for purposes of determining a |
|
63-day period referred to in 29 U.S.C. Section 1181(c)(2), 42 |
|
U.S.C. Section 300gg(c)(2), 26 U.S.C. Section 9801(c)(2), and |
|
Sections 846.202(d), 1501.102, and 1506.001(8). |
|
(e) Not later than the 60th day after the effective date of |
|
Senate Bill 1771, Acts of the 81st Legislature, Regular Session, |
|
2009, an employer or group policy or contract holder shall provide |
|
notice to any former employee, member, dependent, or enrollee who |
|
is an extended election eligible individual that includes: |
|
(1) a description of the extended election period |
|
available to the individual under this section; |
|
(2) a description, displayed in a prominent manner, of |
|
the individual's right to a reduced premium and any conditions on |
|
entitlement to the reduced premium under the American Recovery and |
|
Reinvestment Act of 2009; |
|
(3) a form that allows the individual to request |
|
treatment as an assistance eligible individual, as defined by the |
|
American Recovery and Reinvestment Act of 2009, to whom the premium |
|
subsidy would apply; |
|
(4) the amount continuation coverage will cost and the |
|
period of coverage available; |
|
(5) an election form that includes the return address |
|
and the due date for making the election; and |
|
(6) notice that if the individual is entitled to the |
|
reduced premium and later becomes eligible for other group health |
|
plan coverage or Medicare, the individual must notify the employer |
|
in writing or the individual may be subject to a tax penalty. |
|
Sec. 1202A.002. EXPIRATION OF CHAPTER. This chapter |
|
expires September 1, 2013. |
|
SECTION 2. Section 1251.253, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1251.253. REQUEST FOR CONTINUATION OF GROUP COVERAGE. |
|
An employee, member, or dependent must provide to the employer or |
|
group policyholder a written request for [in writing the] |
|
continuation of group coverage not later than the 60th [31st] day |
|
after the later of: |
|
(1) the date the group coverage would otherwise |
|
terminate; or |
|
(2) the date the individual is given, in a format |
|
prescribed by the commissioner, notice by either the employer or |
|
the group policyholder of the right to continuation of group |
|
coverage. |
|
SECTION 3. Section 1251.254, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1251.254. PAYMENT OF CONTRIBUTIONS. Except as |
|
provided by this section, an [(a) An] employee, member, or |
|
dependent who elects to continue group coverage under this |
|
subchapter must pay to the employer or group policyholder[,] each |
|
month [in advance,] the amount of contribution required by the |
|
employer or policyholder, plus two percent of the group rate for the |
|
coverage being continued under the group policy [on the due date of
|
|
each payment]. A payment under this section must be made not later |
|
than the 45th day after the date of the initial election for |
|
coverage and on the due date of each payment thereafter. Following |
|
the first payment made after the initial election for coverage, the |
|
payment of any other premium shall be considered timely if made on |
|
or before the 30th day after the date on which the payment is due. |
|
[(b)
The employee's, member's, or dependent's written
|
|
election for continuation of group coverage, together with the
|
|
first contribution required to establish advance monthly
|
|
contributions, must be given to the employer or policyholder not
|
|
later than the later of:
|
|
[(1)
the 31st day after the date coverage would
|
|
otherwise terminate; or
|
|
[(2)
the date the individual is given notice by either
|
|
the employer or the group policyholder of the right to continuation
|
|
of group coverage.] |
|
SECTION 4. Section 1251.255, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1251.255. TERMINATION OF CONTINUED COVERAGE. (a) |
|
Group coverage continued under this subchapter may not terminate |
|
until the earliest of: |
|
(1) the date the maximum continuation period provided |
|
by law would end, which is: |
|
(A) for any employee, member, or dependent not |
|
eligible for continuation coverage under Title X, Consolidated |
|
Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 |
|
et seq.) (COBRA), nine [six] months after the date the employee, |
|
member, or dependent elects to continue the group coverage; or |
|
(B) for any employee, member, or dependent |
|
eligible for continuation coverage under COBRA, six additional |
|
months following any period of continuation coverage provided under |
|
COBRA; |
|
(2) the date failure to make timely payments would |
|
terminate the group coverage; |
|
(3) the date the group coverage terminates in its |
|
entirety; |
|
(4) the date the insured is or could be covered under |
|
Medicare; |
|
(5) the date the insured is covered for similar |
|
benefits by another plan or program, including: |
|
(A) a hospital, surgical, medical, or major |
|
medical expense insurance policy; |
|
(B) a hospital or medical service subscriber |
|
contract; or |
|
(C) a medical practice or other prepayment plan; |
|
(6) the date the insured is eligible for similar |
|
benefits, whether or not covered for those benefits, under any |
|
arrangement of coverage for individuals in a group, whether on an |
|
insured or uninsured basis; or |
|
(7) the date similar benefits are provided or |
|
available to the insured under any state or federal law other than |
|
continuation coverage under Title X, Consolidated Omnibus Budget |
|
Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) |
|
(COBRA). |
|
(b) Not later than the 30th day before the end of the |
|
continuation period described by Subsection (a)(1) that is |
|
applicable to the individual [six months after the date the
|
|
employee, member, or dependent elects to continue group coverage
|
|
under the policy], the insurer shall: |
|
(1) notify the individual that the individual may be |
|
eligible for coverage under the Texas Health Insurance Risk Pool as |
|
provided by Chapter 1506; and |
|
(2) provide to the individual the address for applying |
|
to that pool. |
|
SECTION 5. Section 1271.302, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1271.302. REQUEST FOR CONTINUED COVERAGE; DEADLINE. |
|
An enrollee must provide to the employer or group contract holder |
|
[make] a written notice of election to continue group coverage |
|
under this subchapter [and pay the first contribution required to
|
|
establish contributions on an advance monthly basis to the employer
|
|
or group contract holder] not later than the 60th [31st] day after |
|
the later of: |
|
(1) the date the group coverage would otherwise |
|
terminate; or |
|
(2) the date the enrollee is given notice of the right |
|
of continuation by the employer or group contract holder. |
|
SECTION 6. Section 1271.303(b), Insurance Code, is amended |
|
to read as follows: |
|
(b) The enrollee must make the payment not later than the |
|
45th day after the initial election for coverage and on the due date |
|
of each payment thereafter. Following the first payment made after |
|
the initial election for coverage, the payment of any other premium |
|
shall be considered timely if made by the 30th day after the date on |
|
which payment is due [in advance on a monthly basis on the due date
|
|
of each payment]. |
|
SECTION 7. Section 1271.304, Insurance Code, is amended to |
|
read as follows: |
|
Sec. 1271.304. TERMINATION OF CONTINUED COVERAGE. Group |
|
continued coverage under this subchapter may not terminate until |
|
the earliest of: |
|
(1) the date the maximum continuation period provided |
|
by law would end, which is: |
|
(A) for any enrollee not eligible for |
|
continuation coverage under Title X, Consolidated Omnibus Budget |
|
Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) |
|
(COBRA), the end of the nine-month [six-month] period after the |
|
date the election to continue coverage is made; or |
|
(B) for any enrollee eligible for continuation |
|
coverage under COBRA, six additional months following any period of |
|
continuation provided under that statute; |
|
(2) the date on which failure to make timely payments |
|
terminates coverage; |
|
(3) the date on which the enrollee is covered for |
|
similar services and benefits by any other plan or program, |
|
including a hospital, surgical, medical, or major medical expense |
|
insurance policy, hospital or medical service subscriber contract, |
|
or medical practice or other prepayment plan; or |
|
(4) the date on which the group coverage terminates in |
|
its entirety. |
|
SECTION 8. Section 1271.305(a), Insurance Code, is amended |
|
to read as follows: |
|
(a) At least 30 days before the end of the continuation |
|
[six-month] period described by Section 1271.304(1) that is |
|
applicable to the enrollee [after the date an enrollee elects to
|
|
continue group coverage], the health maintenance organization |
|
shall notify the enrollee that the enrollee may be eligible for |
|
coverage under the Texas Health Insurance Risk Pool as provided by |
|
Chapter 1506. |
|
SECTION 9. Section 1506.153, Insurance Code, is amended by |
|
adding Subsections (c) and (d) to read as follows: |
|
(c) An individual eligible for benefits from the |
|
continuation of coverage under Subchapter F or G, Chapter 1251, or |
|
Subchapter G, Chapter 1271, who did not elect continuation coverage |
|
during the election period, or whose elected continuation coverage |
|
lapsed or was canceled without reinstatement, is eligible for pool |
|
coverage. Eligibility under this subsection is subject to a |
|
180-day exclusion of coverage under Section 1506.155(a-1). |
|
(d) The 180-day exclusion of coverage provided under |
|
Subsection (c) does not apply to an individual eligible for |
|
benefits from the continuation of coverage under Subchapter F or G, |
|
Chapter 1251, or Subchapter G, Chapter 1271, who did not elect |
|
continuation coverage during the election period, or whose elected |
|
continuation coverage lapsed or was canceled without |
|
reinstatement, following a period of continuation coverage under |
|
Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 |
|
U.S.C. Section 1161 et seq.) (COBRA). |
|
SECTION 10. Section 1506.155(a-1), Insurance Code, is |
|
amended to read as follows: |
|
(a-1) Except as provided by Section 1506.056, pool coverage |
|
for an individual eligible pursuant to Section 1506.153(b) or (c) |
|
excludes charges or expenses incurred before the expiration of 180 |
|
days from the effective date of coverage with regard to any |
|
condition for which: |
|
(1) the existence of symptoms would cause an |
|
ordinarily prudent person to seek diagnosis, care, or treatment |
|
within the six-month period preceding the effective date of |
|
coverage; or |
|
(2) medical advice, care, or treatment was recommended |
|
or received during the six-month period preceding the effective |
|
date of coverage. |
|
SECTION 11. (a) Sections 1251.253 and 1271.302, Insurance |
|
Code, as amended by this Act, apply only to: |
|
(1) a request for continuation of group coverage that |
|
an employee, member, dependent, or enrollee becomes eligible to |
|
make on or after the effective date of this Act; or |
|
(2) a request for continuation of group coverage that |
|
an employee, member, dependent, or enrollee became eligible to make |
|
before the effective date of this Act, provided that the election |
|
period available to the employee, member, dependent, or enrollee |
|
under Section 1251.253 or 1271.302, Insurance Code, as those |
|
sections existed before amendment by this Act, has not expired as of |
|
the effective date of this Act. |
|
(b) A request for continuation of group coverage that an |
|
employee, member, dependent, or enrollee became eligible to make |
|
before the effective date of this Act and that, on the effective |
|
date of this Act, the employee, member, dependent, or enrollee is no |
|
longer eligible to make, is governed by the law as it existed before |
|
the effective date of this Act, and that law is continued in effect |
|
for that purpose. This subsection does not apply to an employee, |
|
member, dependent, or enrollee who is an extended election eligible |
|
individual to whom Chapter 1202A, Insurance Code, as added by this |
|
Act, applies. |
|
SECTION 12. Sections 1251.254 and 1271.303, Insurance Code, |
|
as amended by this Act, apply only to a payment for continuation |
|
coverage required to be made on or after the effective date of this |
|
Act. A payment for continuation coverage required to be made before |
|
the effective date of this Act is governed by the law as it existed |
|
before that date, and that law is continued in effect for that |
|
purpose. |
|
SECTION 13. Sections 1251.255 and 1271.304, Insurance Code, |
|
as amended by this Act, apply to coverage for which an election to |
|
continue was made on or after the effective date of this Act. |
|
SECTION 14. This Act takes effect immediately if it |
|
receives a vote of two-thirds of all the members elected to each |
|
house, as provided by Section 39, Article III, Texas Constitution. |
|
If this Act does not receive the vote necessary for immediate |
|
effect, this Act takes effect September 1, 2009. |