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A BILL TO BE ENTITLED
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AN ACT
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relating to a uniform coordination of benefits questionnaire for |
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health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1203, Insurance Code, is amended by |
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adding Subchapter D to read as follows: |
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SUBCHAPTER D. COORDINATION OF BENEFITS QUESTIONNAIRE |
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Sec. 1203.151. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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issued by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a Lloyd's plan operating under Chapter 941; or |
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(8) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) alternative health benefit coverage offered by a |
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subsidiary of the Texas Mutual Insurance Company under Subchapter |
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M, Chapter 2054; |
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(8) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(9) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(10) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(11) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; and |
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(12) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code. |
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Sec. 1203.152. CREATION OF UNIFORM COORDINATION OF BENEFITS |
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QUESTIONNAIRE. In collaboration with appropriate stakeholders, |
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the commissioner shall adopt rules establishing a uniform |
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coordination of benefits questionnaire to be used by all health |
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benefit plan issuers in this state. |
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Sec. 1203.153. UNIFORM COORDINATION OF BENEFITS |
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QUESTIONNAIRE REQUIRED. Each health benefit plan issuer that |
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issues a health benefit plan that includes a coordination of |
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benefits provision shall use the uniform coordination of benefits |
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questionnaire established under Section 1203.152 and make the |
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questionnaire available to health care providers as appropriate. |
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SECTION 2. (a) Not later than the 121st day after the |
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effective date of this Act, the commissioner of insurance shall |
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adopt rules establishing the uniform coordination of benefits |
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questionnaire under Section 1203.152, Insurance Code, as added by |
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this Act. |
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(b) The changes in law made by this Act apply only to the use |
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Introduced: ()