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80C393(2) PB

CONFORMING AMENDMENT.

Subtitle A, Title 8, Insurance Code, is amended by adding

Chapter 1214 to read as follows:

CHAPTER 1214.

ADVERTISING FOR CERTAIN HEALTH BENEFITS

Revised Law

1214.001.

APPLICABILITY OF CHAPTER.

This

chapter applies only 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 or agreement, a group hospital service contract, or an individual or group evidence of coverage issued by:

an insurance company;

a group hospital service corporation operating under

Chapter 842;

a health maintenance organization operating under

Chapter 843; or

an approved nonprofit health corporation holding a certificate of authority under

Chapter 844. (V.T.I.C. Art.

21.20-2,

Sec. 1(a).)

Source Law

This

article applies only 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 or agreement, a group hospital service contract, or an individual or group evidence of coverage issued by:

an insurance company;

a group hospital service corporation operating under

Chapter 20 of this code;

a health maintenance organization operating under the Texas Health Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance Code); or

an approved nonprofit health corporation that is certified under

Section 5.01(a), Medical Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and that holds a certificate of authority issued by the commissioner under

Article 21.52F of this code.

Revisor's Note

Section 1(a)(4), V.T.I.C.

Article 21.20-2, refers to a benefit agreement offered by a nonprofit health corporation "certified under

Section 5.01(a), Medical Practice Act" and holding a certificate of authority "issued by the commissioner under

Article 21.52F." The revised law omits the reference to certification under the Medical Practice Act as unnecessary because V.T.I.C.

Article 21.52F, revised in 2001 as

Chapter 844, requires a nonprofit health corporation to be certified under the Medical Practice Act as a condition of holding a certificate of authority.

The revised law also omits as unnecessary the reference to the commissioner issuing the certificate of authority because

Chapter 844 requires the commissioner to issue the certificate of authority.

Revised Law

1214.002.

EXCEPTION.

This

chapter does not apply to:

a plan that provides coverage:

only for a specified disease;

only for accidental death or dismemberment; or

for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or

a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefits so comprehensive that the policy is a health benefit plan as described by

Section 1214.001. (V.T.I.C. Art.

21.20-2,

Sec. 1(b).)

Source Law

This

article does not apply to:

a health benefit plan that provides coverage:

only for a specified disease;

only for accidental death or dismemberment; or

for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or

a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Subsection (

a) of this section.

Revisor's Note

Section 1(b)(1), V.T.I.C.

Article 21.20-2, refers to a "health benefit plan."

The revised law substitutes "plan" for "health benefit plan" for accuracy.

The plans described by

Section 1(b)(1)(C),

Article 21.20-2, as providing coverage for certain lost wages may include plans other than health benefit plans.

Revised Law

1214.003.

RATE INFORMATION DISCLAIMERS.

Subject to

Chapter 541 and

Section 543.001, an advertisement for a health benefit plan may include rate information without including information about each benefit exclusion or limitation if the advertisement includes prominent disclaimers clearly indicating that:

the rates are illustrative;

a person should not send money to the health benefit plan issuer in response to the advertisement;

a person cannot obtain coverage under the plan until the person completes an application for coverage; and

benefit exclusions or limitations may apply to the plan.

An advertisement that states a rate must also indicate the age, gender, and geographic location on which the rate is based.

(V.T.I.C. Art.

21.20-2,

Sec. 2.)

Source Law

Subject to

Article 21.21 of this code, an advertisement for a health benefit plan may include rate information without including information about all benefit exclusions and limitations if the advertisement includes prominent disclaimers that clearly indicate that:

the rates are illustrative;

a person should not send money to the issuer of the health benefit plan in response to the advertisement;

a person cannot obtain coverage under the health benefit plan until the person completes an application for coverage; and

benefit exclusions and limitations may apply to the health benefit plan.

Any rate mentioned in the advertisement shall indicate the age, gender, and geographic location on which that rate is based.

80C77(2) PEP

CHAPTER 1550. CERTAIN REQUIREMENTS FOR INSURERS CONTRACTING

WITH GOVERNMENTAL ENTITIES

SUBCHAPTER A.

REPORTING REQUIREMENTS

Revised Law

1550.001.

DEFINITIONS.

In this subchapter:

"Governmental entity" means:

a state agency; or

a county, municipality, school district, special purpose district, or other subdivision of state government that has jurisdiction limited to a geographic portion of the state.

"Insurer" means:

an insurance company;

a health maintenance organization operating under

Chapter 843; or

an approved nonprofit health corporation that holds a certificate of authority issued under

Chapter 844.

(V.T.I.C. Art. 21.49-15,

Sec. 1.)

Source Law

21.49-15

In this article:

"Governmental entity" means a state agency or political subdivision of this state.

"Insurer" means:

an insurance company;

a health maintenance organization operating under the Texas Health Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance Code); or

an approved nonprofit health corporation that holds a certificate of authority issued by the commissioner under

Article 21.52F of this code.

"Political subdivision" means a county, municipality, school district, special purpose district, or other subdivision of state government that has jurisdiction limited to a geographic portion of the state.

Revisor's Note

Section 1(2), V.T.I.C.

Article 21.49-15, refers to an approved nonprofit health corporation that holds a certificate of authority "issued by the commissioner" under V.T.I.C.

Article 21.52F.

The revised law omits the quoted language as unnecessary because only the commissioner is authorized to issue a certificate of authority under

Article 21.52F, revised as

Chapter 844 of this code.

Revised Law

1550.002.

REPORT REQUIRED.

This

section applies to a contract subject to competitive bidding under which an insurer delivers, issues for delivery, or renews a health insurance policy or contract or an evidence of coverage.

An insurer that enters into a contract described by Subsection (

a) with a governmental entity shall provide to the governmental entity a detailed report that includes:

the claims experience of the governmental entity during the preceding calendar year;

the dollar amount of each large claim, as defined by the governmental entity, paid by the insurer under the contract during the preceding calendar year.

(V.T.I.C. Art. 21.49-15,

Sec. 2(a).)

Source Law

Each insurer that ente