Commissioner’s Bulletin # Summary of Health Care Coverage/Life Related Legislation Enacted - 75th Legislative Session

(House Bills Only)

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 1 (HB 1) General Appropriations Bill, page VIII-34 relating to Report on Health Insurance Mandates

Effective Date of Statute 9/1/97

Requirements of Statute

Health Insurance Mandate - The Texas Department of Insurance (TDI) to prepare report on the costs and benefits of health insurance mandates. (Note: HB 2063 repealed the Mandated Review Panel and Article 21.52D.)

Responsibility of and/or Action Needed by Carriers

Respond to any data call requested by TDI.

Responsibility of and/or Action Needed by TDI

Research each health mandate, prepare and submit report.

Applicable Date of Compliance

The report is due to the 76th Legislature.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 3 (HB 3) relating to the Texas Healthy Kids Corporation and Other Health Benefit Coverage SECTIONS 1, 5, 6 and 7 - Texas Healthy Kids Corporation - adds Chapter 109 to the Health and Safety Code

Effective Date of Statute 6/2/97

Requirements of Statute

The Texas Health Kids Corporation (THKC) - The primary purpose of the THKC is to provide primary and preventive health care for children. The corporation is a non-profit corporation and is not subject to franchise tax - Sec. 109.031. The corporation is under the general supervision of a board of directors. The initial board of directors of the THKC is to be appointed by the governor with advice and consent of Senate. Additional members of the board include the Commissioner of Health and Human Services, the Commissioner of Insurance and the director of the Title IV-D Agency - SECTION 5 of HB 3. THKC will gradually decrease its affiliation with the state. By 2003, all members appointed by the governor will have been replaced with Board members selected in accordance with the articles and by-laws of the Board - SECTION 5 of HB 3.

Responsibility of and/or Action Needed by Carriers

Monitor development of THKC.

Responsibility of and/or Action Needed by TDI

The Commissioner of Insurance is to take steps to incorporate the THKC - SECTION 6 of HB 3. The Commissioner of Insurance (or his designee) will serve as a member.

Applicable Date of Compliance

Articles of incorporation filed with Secretary of State on 7/16/97.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

The initial board shall propose (a) a plan of operation and any other standards adopted by the board and (b) the health benefits programs and plans and submit to the Commissioner for approval.

Responsibility of and/or Action Needed by Carriers

Monitor development of plan of operation/standard health benefit plans.

Responsibility of and/or Action Needed by TDI

Commissioner to review and approve by-laws, plans of operations, benefit plans, etc.

Applicable Date of Compliance

By 6/2/98 the Board shall establish procedures, and the design/ benefit structure of the health benefit plans - SECTION 7 of HB 3.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

The board is to employ an executive director. The executive director may hire employees or consultants to administer the program.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

The Commissioner is to employ an acting executive director of the Texas Health Kids Corporation - SECTION 6 of HB 3. The Commissioner has authority to accept grants and gifts of money, property or services to assist the acting executive director in carrying out the powers of the acting executive director. Authority of the Commissioner to accept grants, gifts, etc. expires on the date all appointed members of the board are appointed - SECTION 6 of HB 3.

Applicable Date of Compliance

On 8/15/97 Tyrette Hamilton was appointed acting executive director. She may be contacted at 512/305-7404

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

The Health and Human Service Agency, the Department of Insurance, the Title IV-D Agency and the Board of Directors of the High Risk Pool and the Comptroller are to cooperate and assist the corporation in carrying out its duties. Secs. 109.032 - 109.038.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Provide assistance as necessary.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

The corporation shall establish a program to provide health benefits for eligible children in this state (children who are not covered by insurance or any other type of health benefits plan, not covered for a specified condition or not covered for primary and preventive care). Coverage may only be provided through eligible coverage providers (insurers and HMOs - Sec. 109.063). The corporation may provide group coverage to children in specified geographic regions of Texas or based on other criteria approved by the Commissioner of Insurance - Sec. 109.061. Premiums and copayments/deductibles are the responsibility of the parent/managing conservator/ guardian or other sponsor of a child. A sliding scale premium structure may be developed by the board based on the ability to pay - Sec. 109.061.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Commissioner to review criteria submitted.

Applicable Date of Compliance

Initial coverage under the THKC shall be offered no later than 6/2/98, - SECTION 7 of HB 3.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

Coverage under the THKC is secondary to any other PRIVATE insurance - Sec. 109.061. Participating eligible providers (insurers/HMOs) may be required to market the benefit program. Direct sales and solicitation must be conducted in accordance with the Insurance Code and insurance laws of this state - Sec. 109.061. The corporation is NOT an insurer and may NOT self-fund any portion of the benefit plan. The corporation, its employees and board members are not subject to any licensing requirements under insurance laws - Sec. 109.062.

Responsibility of and/or Action Needed by Carriers

Ensure marketing materials comply with applicable laws and regulations. Inform staff.

Responsibility of and/or Action Needed by TDI

Inform staff.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

Eligible coverage providers must be a licensed entity holding an appropriate certificate of authority that satisfies all insurance laws. Health benefit plans provided by the corporation are not subject to mandated benefit laws. Eligible coverage providers are not subject to premium tax for moneys received for coverage provided under this law.

Responsibility of and/or Action Needed by Carriers

Contact THKC if interested in being a provider. Modify systems to accommodate reporting of premium taxes.

Responsibility of and/or Action Needed by TDI

Provide information on licensed entities. Inform staff.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

The corporation shall not permit an eligible coverage provider to establish school based clinics for treatment of services (except for routine health screening and preventive measuring including immunizations, inoculations and hearing and vision testing) - Sec. 109.063. The corporation shall develop a plan for receipt and consideration of complaints - Sec. 109.065. The corporation shall notify the parent/managing conservator/guardian of a child who applies for coverage through the corporation of the availability for coverage from the risk pool under Article 3.77, Texas Insurance Code (HB 710) - Sec. 109.067.

Responsibility of and/or Action Needed by Carriers

Inform staff. Monitor development of complaint procedures.

Responsibility of and/or Action Needed by TDI

Inform staff.

Applicable Date of Compliance

Procedures for complaints to be developed by 6/2/98 - SECTION 7, HB 3.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - THKC Continued

Effective Date of Statute

Requirements of Statute

Coverage required by a medical support order is addressed in Secs. 109.101 - 109.103. Coverage for a child shall be terminated for failure to pay premiums (except as provided under the premium stabilization fund under Secs. 109.152 - 109.151). The premium stabilization revolving account is comprised of funds collected, appropriated or donated. The corporation shall charge a premium stabilization fee which shall be deposited in the premium stabilization revolving account. Moneys from the premium stabilization fund may only be used to pay premium of a covered child whose premium has not been paid as required - Secs. 109.052 - 109.054.

Responsibility of and/or Action Needed by Carriers

Inform staff.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Continued SECTION 2 amends the Family Code

Effective Date of Statute

Requirements of Statute

Section 154.183 of the Family Code was amended to allow, in relation to medical support orders, for coverage through the THKC.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents).

Responsibility of and/or Action Needed by TDI

Inform staff.

Applicable Date of Compliance

A court may not order coverage thru the THKC before the date the THKC first offers coverage in the applicable region of the state - SECTION 9 of HB 3.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Continued SECTION 3 amends the Tax Code

Effective Date of Statute

Requirements of Statute

Section 171.063(a) of the Tax Code was amended stating that charity care and community benefits required by a nonprofit hospital may be satisfied by a donation of money to the THKC.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

1/1/98 and applies to a report originally due on or after that date - SECTION 11 of HB 3.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Continued SECTION 4 adds a new Chapter 27 (Articles 27.01-27.06) to the Texas Insurance Code

Effective Date of Statute

Requirements of Statute

Scope of Chapter 27, TIC - This chapter applies to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, a group, blanket, or franchise insurance policy/agreement, a group hospital service contract, or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F), to the extent permitted by the Employee Retirement Income Security Act of 1974, a multiple employer welfare arrangement or another analogous benefit arrangement or any other entity that contracts directly for health care services - Article 27.02.

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Chapter 27, TIC Continued

Effective Date of Statute

Requirements of Statute

Children s Health Benefit Plan - An issuer of a health benefit plan may offer a children s health benefit plan only to children younger than 18 years of age. The health benefit plan and benefits must be approved by the commissioner - Article 27.03.

Responsibility of and/or Action Needed by Carriers

Any plan issued under Chapter 27 is subject to the commissioner s approval. If proposed, monitor development of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.

Applicable Date of Compliance

Coverage may not be offered before 1/1/98 - SECTION 8 of HB 3.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Chapter 27, TIC Continued

Effective Date of Statute

Requirements of Statute

Mandated Benefit Provisions Inapplicable - A health benefit plan under this Chapter is not subject to a law requiring coverage or the offer of coverage of health care services or benefits - Article 27.04.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents).

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Chapter 27, TIC Continued

Effective Date of Statute

Requirements of Statute

Exemption From Premium Tax - Money received for coverage provided under this Chapter is not subject to premium tax imposed by Article 4.11 or Article 20A.33, Texas Insurance Code - Article 27.05.

Responsibility of and/or Action Needed by Carriers

Modify systems to accommodate reporting of premium taxes.

Responsibility of and/or Action Needed by TDI

Inform staff.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 3 - Chapter 27, TIC Continued

Effective Date of Statute

Requirements of Statute

Rules - The commissioner may adopt rules to implement this chapter - Article 27.06.

Responsibility of and/or Action Needed by Carriers

Monitor development and adoption of rules.

Responsibility of and/or Action Needed by TDI

Evaluate and propose rules, if necessary. Take any other necessary action.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 39 (HB 39) relating to Genetic Testing SECTION 3 adds Article 21.73 to the Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Scope of Article - This article applies to a group health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including a group, blanket, or franchise insurance policy/agreement, a group hospital service contract or evidence of coverage this is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F) or to the extent permitted by the Employee Retirement Income Security Act, a multiple employer welfare arrangement , any other entity that contracts directly for health care services or another analogous benefit arrangement - Article 21.73, Sec. 2(a).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

This article does NOT apply to a plan that provides coverage only for a specified disease, accidental death or dismemberment, disability income, as a supplement to liability insurance, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy; or a long term care policy - Article 21.73, Sec. 2(b).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

Use of Genetic Information by Group Health Benefit Plan - A group health benefit plan issuer may not use genetic information (i.e., information derived from genetic test) to reject, deny, limit, cancel, refuse to renew, increase the premiums for, or otherwise adversely affect eligibility for or coverage under the group health benefit plan - Article 21.73, Sec. 3(a).

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development of rules. Develop or revise any and all procedures including, but not limited to, underwriting, rating, marketing procedures and agents training materials to comply with this new article.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Revise checklists and other educational materials/ brochures. Take any other necessary action.

Applicable Date of Compliance

Applies to a group health benefit plan issued, delivered or renewed on or after 1/1/98 - SECTION 6 of HB 39.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

If an insurer requests that an applicant submit to a genetic test, the issuer must (1) notify the applicant that the test is required; (2) disclose the proposed use of the test results; and (3) obtain the applicant s written informed consent for the test before administration of the test - Article 21.73, Sec. 3(b).

Responsibility of and/or Action Needed by Carriers

Amend or develop informed consent forms in accordance with the new statute.

Responsibility of and/or Action Needed by TDI

Evaluate proposing a promulgated consent form.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

The consent form must contain a statement regarding whether or not the applicant elects to be informed of the results of the test. If the applicant elects to be informed, the person or entity that performs the test shall disclose the results of the test to the applicant and the group health benefit plan issuer - Article 21.73, Sec. 3(c).

Responsibility of and/or Action Needed by Carriers

Issuers utilizing genetic testing must develop procedures for informing individuals of results of genetic testing.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

An issuer shall ensure that the applicant receives an interpretation of the test results from a qualified health care practitioner and that a physician or other health care practitioner designated by the applicant receives a copy of the test - Article 21.73, Sec. 3(c). Additionally, requirements for the "right to know test results" are contained in Article 21.73, Sec. 5.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Revise checklists and other educational materials/ brochures. Take any other necessary action.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

Prohibitions - An insurer may not use the results of the genetic test as an inducement to purchase coverage - Article 21.73, Sec. 3(d). An insurer may not use the refusal of an applicant to submit to a genetic test to reject, deny, limit, cancel, refuse to renew, increase premiums for or otherwise adversely affect eligibility for coverage under the group health benefit plan - Article 21.73, Sec. 3(e).

Responsibility of and/or Action Needed by Carriers

Inform staff. Revise any and all procedures including but not limited to underwriting, rating, marketing procedures and agents training materials to comply with this new article.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

Genetic information is confidential - A person or entity that holds genetic information may not disclose or be compelled to disclose (by subpoena or otherwise) genetic information without written authorization from an individual. The statute sets forth criteria for (a) the informed consent form, (b) exceptions for release of information without prior written consent and (c) redisclosure - Article 21.73, Sec. 4. Retention of genetic material taken for a genetic test shall be destroyed promptly after the purpose for which it is obtained. The statute sets forth criteria for exceptions to destruction - Article 21.73, Sec. 6.

Responsibility of and/or Action Needed by Carriers

Develop procedures for informing individuals of results of genetic testing and complying with confidentiality and redisclosure requirements.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

Administrative action - The commissioner may, upon finding that a group health benefit plan issuer has violated this Article, enter into a cease and desist order as provided under Article 1.10A. The statute sets forth other administrative action the commissioner may take for violations of this statute - Article 21.73, Sec. 7.

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Investigate alleged violations and take any other necessary administrative action.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 39 - Continued

Effective Date of Statute

Requirements of Statute

Genetic testing of a child in utero may NOT be required as a condition of coverage for a pregnant woman without the consent of the woman. No genetic information shall be used to compel or coerce a pregnant woman to have an induced abortion - Article 21.73, Sec. 8.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development of rules. Revise any and all procedures including, but not limited to, underwriting, rating, marketing procedures and agents training materials to comply with this new article.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Revise checklists and other educational materials/brochures. Take any other necessary action.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 102 (HB 102) relates to Minimum Inpatient Stay in a Health Care Facility and Postdelivery Care following Birth of a Child SECTION 1 - adds Article 21.53F to the Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Scope of Article - This article applies to a health benefit plan 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/agreement, a group hospital service contract or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F) or to the extent permitted by the Employee Retirement Income Security Act, a multiple employer welfare arrangement, any other entity that contracts directly for health care services or another analogous benefit arrangement - Article 21.53F, Sec. 2(a).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 102 - Continued

Effective Date of Statute

Requirements of Statute

This article does NOT apply to a plan that provides coverage only for a specified disease or other limited benefit; accidental death or dismemberment; disability income, as a supplement to liability insurance, credit insurance, dental or vision care only, indemnity for hospital confinement, a small employer health plan under Chapter 26, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy; or a long term care policy. - Article 21.53F, Sec. 2(b).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

The exemption of small employer plans does not comply with Federal law. Rules will be proposed to address this issue.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 102 - Continued

Effective Date of Statute

Requirements of Statute

Required Coverage for Minimum Inpatient Stay Following Birth; Exceptions - A health benefit plan that provides maternity benefits, including benefits for childbirth, must include coverage for inpatient care for a mother and her newborn child in a health care facility for a minimum of (a) 48 hours following uncomplicated vaginal delivery, and (b) 96 hours following uncomplicated C-section. A health care plan that provides in-home postdelivery care is not required to provide the minimum number of hours unless the inpatient care is determined to be medically necessary by the attending physician or is requested by the mother. This statute does not require a mother who is eligible for coverage to (a) give birth in a hospital or other health care facility or (b) remain in a hospital or other facility for any fixed term - Article 21.53F, Sec. 4.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Develop/propose and adopt rules. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance

Applies to any policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 2 of HB 102.

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 102 - Continued

Effective Date of Statute

Requirements of Statute

Postdelivery Care - If a mother or newborn child is discharged before the expiration of the minimum hours required, the health benefit plan must provide for timely postdelivery care (as defined in the bill). Care must be provided by a physician, registered nurse or other appropriate licensed provider and may be provided at the mother s home, a health care provider s office/facility or any other location determined appropriate under rules adopted by the commissioner. The mother must be allowed the option to have the care provided in the mother s home - Article 21.53F, Sec. 5.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 102 - Continued

Effective Date of Statute

Requirements of Statute

Prohibitions - An insurer may not (a) modify the terms of coverage based on the determination by an enrollee to request less than the minimum coverage required; (b) offer the mother financial incentives contingent on waiver of the minimum coverage required; (c) refuse to accept a physician s recommendation if the period recommended does not exceed guidelines developed by nationally recognized professional associations of OBGYNs or pediatricians; (d) reduce payments or other forms of reimbursement for inpatient care below the usual and customary rate; or (e) penalize a physician for recommending inpatient care for a mother or her newborn child - Article 21.53F, Sec. 6.

Responsibility of and/or Action Needed by Carriers

Review and revise any and all procedures/documents.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 102 - Continued

Effective Date of Statute

Requirements of Statute

Notice - In accordance with rules adopted by the commissioner, a health benefit plan must provide to each enrollee under the plan written notice regarding the coverage under this statute - Article 21.53F, Sec 7.

Responsibility of and/or Action Needed by Carriers

Monitor development and adoption of rules. Provide notice as required.

Responsibility of and/or Action Needed by TDI

Develop and propose rules.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 102 - Continued

Effective Date of Statute

Requirements of Statute

Rules - The commissioner shall adopt rules as necessary to administer this article - Article 21.53F, Sec. 8.

Responsibility of and/or Action Needed by Carriers

Monitor development and adoption of rules.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 163 (HB 163) relating to Accelerated Benefits and Irrevocable Designation of Beneficiary (under the Texas Employees Uniform Group Insurance Benefits Act) SECTION 1 adds Sec. 11A to Article 3.50-2, Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Payment of Accelerated Benefits; Irrevocable Designation of Beneficiary - The trustee shall adopt rules requiring a group life insurance program provided to employees/annuitants/dependents, to include a provision allowing the individual to (a) elect and receive accelerated benefits under Article 3.50-6 or (b) make, in conjunction with a viatical settlement, an irrevocable designation of beneficiary.

Responsibility of and/or Action Needed by Carriers

Monitor development of rules by trustee.

Responsibility of and/or Action Needed by TDI

Offer assistance to trustee and monitor development of rules.

Applicable Date of Compliance

Applies to a group life policy that is delivered, issued for delivery or renewed on or after 9/1/97. Individuals may not elect accelerated benefits or designate an irrevocable beneficiary before 1/1/98 - SECTION 2 of HB 163.