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A BILL TO BE ENTITLED
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AN ACT
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relating to submission and payment of claims under long-term care |
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benefit plans; imposing a penalty. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subchapter B, Chapter 1651, Insurance Code, is |
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amended by adding Sections 1651.057, 1651.058, and 1651.059 to read |
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as follows: |
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Sec. 1651.057. SUBMISSION OF CLAIM. An individual covered |
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by a long-term care benefit plan may submit a claim under the plan |
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to the plan issuer by: |
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(1) mailing the claim by United States mail, first |
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class, or by overnight delivery service; |
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(2) submitting the claim electronically; |
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(3) faxing the claim; or |
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(4) hand delivering the claim. |
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Sec. 1651.058. RECEIPT OF CLAIM. (a) If a claim under a |
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long-term care benefit plan is mailed, the claim is presumed to have |
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been received by the plan issuer on the fifth day after the date the |
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claim is mailed or, if the claim is mailed using overnight service |
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or a return receipt is requested, on the date the delivery receipt |
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is signed. |
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(b) If the claim is submitted electronically, the claim is |
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presumed to have been received on the date of transmission. |
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(c) If the claim is faxed, the claim is presumed to have been |
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received on the date of the transmission acknowledgment. |
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(d) If the claim is hand delivered, the claim is presumed to |
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have been received on the date the delivery receipt is signed. |
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Sec. 1651.059. PAYMENT OF CLAIM; PENALTY. (a) A long-term |
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care benefit plan issuer shall pay a claim for which the covered |
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individual is entitled to payment under the terms of the plan not |
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later than the 30th day after the date the plan issuer receives the |
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claim. |
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(b) A long-term care benefit plan issuer that violates |
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Subsection (a) shall pay to the covered individual the amount the |
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plan issuer owes on the claim plus a penalty in the amount of $500. |
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SECTION 2. Sections 1651.057, 1651.058, and 1651.059, |
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Insurance Code, as added by this Act, apply only to a claim |
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submitted on or after the effective date of this Act. A claim |
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submitted before the effective date of this Act is governed by the |
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law as it existed immediately before that date, and that law is |
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continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2015. |