The bill amends the Texas Insurance Code to clarify the obligations of group health benefit plan policyholders regarding premium payments after an individual's eligibility for coverage has terminated. Specifically, it introduces new provisions that allow health maintenance organizations and insurers to waive the contract holder's liability for premiums if they are notified of the termination later than the end of the month in which the eligibility ended. This waiver is contingent upon the condition that no covered services were provided to the enrollee or individual after their eligibility termination.

The new language added to Section 843.210 and Section 1301.0061 specifies that if the notification of termination is delayed, the respective health maintenance organization or insurer may forgo charging premiums for subsequent months. This change aims to provide relief to policyholders in situations where timely notification was not possible, thereby preventing unnecessary financial burdens when no services were rendered post-termination. The bill is set to take effect immediately upon receiving a two-thirds vote from both houses or on September 1, 2025, if such a vote is not achieved.

Statutes affected:
Introduced: Insurance Code 843.210, Insurance Code 1301.0061 (Insurance Code 843, Insurance Code 1301)