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A BILL TO BE ENTITLED
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AN ACT
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relating to changing the Texas Health Insurance Risk Pool to the |
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Texas Health Insurance Pool, and to the operation of that pool. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 1506, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1506. TEXAS HEALTH INSURANCE [RISK] POOL |
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SECTION 2. Subdivision (7), Section 1506.001, Insurance |
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Code, is amended to read as follows: |
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(7) "Pool" means the Texas Health Insurance [Risk] |
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Pool. |
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SECTION 3. Subchapter A, Chapter 1506, Insurance Code, is |
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amended by adding Section 1506.010 to read as follows: |
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Sec. 1506.010. REDESIGNATION. Effective September 1, 2009, |
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the Texas Health Insurance Risk Pool is redesignated the Texas |
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Health Insurance Pool. A reference in any law to the Texas Health |
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Insurance Risk Pool means the Texas Health Insurance Pool. |
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SECTION 4. Section 1506.152, Insurance Code, is amended by |
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amending Subsections (b) and (c) and adding Subsection (f) to read |
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as follows: |
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(b) Subject to Subsection (f), each [Each] dependent of an |
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individual who is eligible for coverage from the pool is also |
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eligible for coverage from the pool. |
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(c) Subject to Subsection (f), if [If] an individual who |
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obtains coverage from the pool under Subsection (a) is a child, each |
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parent, grandparent, brother, sister, or child of that individual |
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who resides with that individual is also eligible for coverage from |
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the pool. |
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(f) A dependent or individual described by Subsection (c) |
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who is not a federally defined eligible individual and who has not |
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experienced a significant break in coverage may not obtain coverage |
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from the pool before the first date on which the dependent or |
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individual has been: |
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(1) a legally domiciled resident of this state for at |
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least the 30 days preceding the date of the application for coverage |
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from the pool; and |
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(2) a citizen or permanent resident of the United |
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States for at least three continuous years. |
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SECTION 5. Section 1506.153, Insurance Code, as amended by |
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Chapters 808 (S.B. 1254), 881 (H.B. 1977), and 1070 (H.B. 2548), |
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Acts of the 80th Legislature, Regular Session, 2007, is reenacted |
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and amended to read as follows: |
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Sec. 1506.153. INELIGIBILITY FOR COVERAGE. (a) Notwithstanding |
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Section 1506.152 [Section 1506.152(a)-(c)], an individual is not |
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eligible for coverage from the pool if: |
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(1) on the date pool coverage is to take effect, the |
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individual has health benefit plan coverage from a health benefit |
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plan issuer or health benefit arrangement in effect, except as |
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provided by Section 1506.152(a)(3)(E); |
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(2) at the time the individual applies to the pool, |
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except as provided in Subsection (b), the individual is eligible |
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for other health care benefits, including an offer of benefits from |
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the continuation of coverage under Title X, Consolidated Omnibus |
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Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et |
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seq.)[, as amended] (COBRA), other than: |
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(A) coverage, including COBRA or other |
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continuation coverage or conversion coverage, maintained for any |
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preexisting condition waiting period under a pool policy or during |
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any preexisting condition waiting period or other waiting period of |
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the other coverage; |
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(B) employer group coverage conditioned by a |
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limitation of the kind described by Section 1506.152(a)(3)(A) or |
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(C); or |
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(C) individual coverage conditioned by a |
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limitation described by Section 1506.152(a)(3)(C) or (D); |
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(3) within 12 months before the date the individual |
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applies to the pool, the individual terminated coverage in the |
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pool, unless the individual: |
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(A) demonstrates a good faith reason for the |
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termination; or |
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(B) is a federally defined eligible individual; |
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(4) the individual is confined in a county jail or |
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imprisoned in a state or federal prison; |
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(5) any of the individual's premiums are paid for or |
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reimbursed under a government-sponsored program or by a government |
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agency or health care provider; |
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(6) the individual's prior coverage with the pool was |
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terminated: |
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(A) during the 12-month period preceding the date |
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of application for nonpayment of premiums; or |
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(B) for fraud; or |
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(7) the individual is eligible for health benefit plan |
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coverage provided in connection with a policy, plan, or program |
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paid for or sponsored by an employer, even though the employer |
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coverage is declined. This subdivision does not apply to an |
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individual who is a part-time employee or a part-time employee's |
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dependent eligible to participate in an employer plan that provides |
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health benefit coverage: |
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(A) that is more limited or restricted than |
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coverage with the pool; and |
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(B) for which there is no employer contribution |
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to the premium, either directly or indirectly. |
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(b) An individual eligible for benefits from the |
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continuation of coverage under Title X, Consolidated Omnibus Budget |
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Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)[, as
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amended] (COBRA), or a comparable federal or state employee |
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coverage continuation program, who did not elect continuation of |
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coverage during the election period, or whose elected continuation |
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of coverage lapsed or was cancelled without reinstatement, is |
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eligible for pool coverage. Eligibility under this subsection is |
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subject to a minimum 180-day exclusion of coverage under Section |
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1506.155(a-1). |
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SECTION 6. Section 1506.155, Insurance Code, is amended by |
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amending Subsection (a-1) and adding Subsection (c-1) to read as |
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follows: |
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(a-1) Except as provided by Section 1506.056, pool coverage |
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for an individual eligible pursuant to Section 1506.153(b) excludes |
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charges or expenses incurred before the first anniversary of [the
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expiration of 180 days from] the effective date of coverage with |
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regard to any condition for which: |
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(1) the existence of symptoms would cause an |
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ordinarily prudent person to seek diagnosis, care, or treatment |
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within the six-month period preceding the effective date of |
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coverage; or |
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(2) medical advice, care, or treatment was recommended |
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or received during the six-month period preceding the effective |
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date of coverage. |
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(c-1) If an individual eligible under Section 1506.153(b) |
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was covered by creditable coverage at any time during the 12-month |
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period immediately preceding the effective date of the individual's |
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coverage under the pool, the pool shall subtract from the exclusion |
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period required under Subsection (a-1) up to 180 days of: |
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(1) the period during which the individual was |
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covered under the creditable coverage; and |
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(2) any waiting period that applied before the |
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creditable coverage became effective. |
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SECTION 7. Subsection (b), Section 1506.2523, Insurance |
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Code, is amended to read as follows: |
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(b) For purposes of this section, gross health benefit plan |
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premiums do not include premiums collected for: |
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(1) coverage under a Medicare supplement benefit plan |
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subject to Chapter 1652; |
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(2) coverage under a small employer health benefit |
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plan subject to Subchapters A-H, Chapter 1501; or |
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(3) coverage or insurance listed in Section |
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1506.002(b), (c), or (d). |
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SECTION 8. This Act applies only to an application for |
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initial or renewal coverage through the Texas Health Insurance Risk |
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Pool under Chapter 1506, Insurance Code, as amended by this Act, |
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that is filed with the pool on or after January 1, 2010. An |
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application filed before that date is governed by the law in effect |
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on the date on which the application was filed, and the former law |
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is continued in effect for that purpose. |
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SECTION 9. This Act takes effect September 1, 2009. |
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* * * * * |