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A BILL TO BE ENTITLED
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AN ACT
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relating to the reporting of certain claims information by certain |
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insurers and health benefit plan issuers to the Texas Department of |
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Insurance. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 38, Insurance Code, is amended by adding |
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Subchapter K to read as follows: |
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SUBCHAPTER K. CLAIM REPORTING BY CERTAIN INSURERS AND HEALTH |
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BENEFIT PLAN ISSUERS |
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Sec. 38.501. CLAIM REPORTING REQUIREMENTS. (a) In this |
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section: |
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(1) "Health benefit plan issuer" means the issuer of a |
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health benefit plan that provides benefits for medical or surgical |
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expenses incurred as a result of a health condition, accident, or |
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sickness, including an individual, group, blanket, or franchise |
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policy or insurance agreement, a group hospital service contract, |
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or an evidence of coverage or similar coverage document. The term |
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includes: |
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(A) a plan issued by: |
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(i) an insurer; |
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(ii) a health maintenance organization |
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operating under Chapter 843; or |
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(iii) a group hospital service corporation |
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operating under Chapter 842; |
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(B) notwithstanding any provision in Chapter |
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1551, 1575, 1579, or 1601: |
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(i) a basic coverage plan under Chapter |
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1551; |
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(ii) a basic plan under Chapter 1575; |
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(iii) a primary care coverage plan under |
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Chapter 1579; or |
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(iv) basic coverage under Chapter 1601; |
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(C) group health coverage made available by a |
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school district in accordance with Section 22.004, Education Code; |
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(D) coverage provided under the state Medicaid |
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program, including the Medicaid managed care program operated under |
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Chapter 533, Government Code; and |
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(E) coverage provided under the child health plan |
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program under Chapter 62, Health and Safety Code. |
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(2) "Insurer" means an insurance company, reciprocal |
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or interinsurance exchange, mutual insurance company, capital |
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stock company, county mutual insurance company, Lloyd's plan, or |
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other legal entity authorized to engage in the business of |
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insurance in this state. |
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(b) An insurer engaged in the business of personal |
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automobile or residential property insurance or a health benefit |
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plan issuer shall submit a quarterly report to the department |
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containing the following information organized by zip code: |
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(1) the number of claims filed with the insurer under |
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personal automobile or residential property insurance policies, as |
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applicable, or the number of health benefit claims filed with the |
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health benefit plan issuer; |
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(2) the number of claims denied; and |
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(3) for each claim denied, the reason for the denial. |
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(c) The commissioner by rule shall adopt the form of the |
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report required under Subsection (b). |
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SECTION 2. Not later than December 31, 2017, the |
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commissioner of insurance shall adopt rules as necessary to |
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implement Subchapter K, Chapter 38, Insurance Code, as added by |
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this Act. The rules must require that an insurer or health benefit |
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plan issuer subject to that subchapter make the initial submission |
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of the report under that subchapter not later than the 60th day |
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after the effective date of the rules. |
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SECTION 3. This Act takes effect September 1, 2017. |