81R2462 KCR-D

By: Shapleigh S.B. No. 206

A BILL TO BE ENTITLED

AN ACT

relating to the reporting of information concerning the cancellation or rescission of health benefit plans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle G, Title 8, Insurance Code, is amended by adding Chapter 1515 to read as follows:

CHAPTER 1515. INFORMATION CONCERNING CANCELED OR RESCINDED HEALTH

BENEFIT PLANS

Sec. 1515.001. APPLICABILITY. (a) This chapter 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 chapter 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 supplemental 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. 1515.002. REPORT. (a) Each health benefit plan issuer authorized to issue health benefit plans in this state shall submit a report to the department containing the cancellation and rescission rates of health benefit plans issued by the issuer.

(b) In addition to the cancellation and rescission rates described by Subsection (a), the report must contain:

(1) the number of health benefit plans canceled or rescinded by the health benefit plan issuer during the reporting period, expressed both in the aggregate and individually for each type of health benefit plan;

(2) the total number of enrollees that were covered by canceled or rescinded health benefit plans before those plans were canceled or rescinded;

(3) the reasons for cancellation or rescission of canceled or rescinded health benefit plans, expressed both in the aggregate and individually for each type of health benefit plan; and

(4) if known by the health benefit plan issuer, information concerning whether an enrollee covered by a health benefit plan that was canceled or rescinded by the health benefit plan issuer during the reporting period subsequently obtained health benefit plan coverage under another health benefit plan, including a health benefit plan issued by the Texas Health Insurance Risk Pool under Chapter 1506.

(c) The commissioner shall adopt rules necessary to implement this section, including rules concerning any applicable reporting period and the form of the report required under Subsection (a).

Sec. 1515.003. INTERNET POSTING; CONSUMER HOTLINE. (a) The department shall post on the department's Internet website:

(1) the information contained in the reports received under Section 1515.002; and

(2) a form through which consumers may report cancellation or rescission of a health benefit plan and complaints or suspected violations of the law governing the cancellation or rescission of health benefit plans.

(b) The department shall operate a toll-free telephone hotline to:

(1) respond to consumer inquiries concerning the cancellation or rescission of health benefit plans; and

(2) provide information to consumers concerning the cancellation or rescission of health benefit plans and technical assistance with the completion of the form described by Subsection (a)(2).

SECTION 2. The commissioner of insurance shall adopt rules under Section 1515.002(c), Insurance Code, as added by this Act, not later than January 1, 2010. The rules must require health benefit plan issuers to submit the first report under Section 1515.002, Insurance Code, as added by this Act, not later than April 1, 2010.

SECTION 3. 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.