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A BILL TO BE ENTITLED
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AN ACT
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relating to prohibition of certain compensation based on |
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rescinding, canceling, or limiting coverage under health benefit |
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plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle C, Title 6, Insurance Code, is amended |
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by adding Chapter 848 to read as follows: |
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CHAPTER 848. CERTAIN COMPENSATION PROHIBITED |
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Sec. 848.001. APPLICABILITY. This chapter applies to a |
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health benefit plan that provides benefits in this state for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) a reciprocal exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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Sec. 848.002. PROHIBITED COMPENSATION. (a) The issuer of a |
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health benefit plan may not permit or provide compensation or |
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another thing of value to a person or entity who is employed by, or |
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who contracts with the issuer to provide services to, the issuer, |
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including an agent, based on, or related in any way to: |
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(1) the number of insurance policies, insurance |
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agreements, contracts, or evidences of coverage that the person or |
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entity has caused or recommended to be rescinded, canceled, or |
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limited; or |
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(2) any resulting savings accruing to the issuer |
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because of adverse determinations regarding claims for benefits, |
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reductions of or limitations on benefits, or other analogous |
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actions. |
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(b) A health benefit plan issuer may not set performance |
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goals or quotas, or provide compensation to any person or entity who |
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is employed by, or who contracts with the issuer to provide services |
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to the issuer, including an agent, based on: |
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(1) the number of persons whose health benefit plan |
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coverage is rescinded; or |
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(2) any financial savings to the issuer associated |
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with rescission of coverage. |
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SECTION 2. This Act takes effect September 1, 2009. |