Texas 2011 - 82nd Regular

Texas House Bill HB3017

Filed
 
Introduced
3/10/11  
Out of House Committee
4/28/11  
Voted on by House
5/11/11  
Refer
3/17/11  
Out of Senate Committee
5/17/11  
Report Pass
4/21/11  
Voted on by Senate
5/24/11  
Engrossed
5/11/11  
Governor Action
6/17/11  
Refer
5/11/11  
Bill Becomes Law
 
Report Pass
5/17/11  
Enrolled
5/24/11  
Enrolled
5/24/11  
Passed
6/17/11  

Caption

Relating to the prohibited use of discretionary clauses in certain health maintenance organization and insurance contracts.

Impact

The implementation of HB3017 will have a significant impact on the Texas Insurance Code, specifically in the areas pertaining to how health coverage and insurance policies are structured. By prohibiting discretionary clauses, insurance companies may need to revise their contracts to comply with this new standard. As a result, policyholders will gain stronger rights to appeal denials of claims, thus potentially increasing the accountability of insurers in their decision-making processes. This shift could lead to a healthier dialogue between insurers and their customers, fostering a more equitable insurance landscape.

Summary

House Bill 3017 seeks to prohibit the use of discretionary clauses in certain health maintenance organization (HMO) and insurance contracts in Texas. By defining what constitutes a discretionary clause, the bill aims to ensure that covered individuals can contest or appeal adverse eligibility decisions or benefit determinations made by HMOs and insurers. This legislative change is geared towards enhancing consumer protections in the health insurance market, allowing policyholders a fair opportunity to challenge unfavorable decisions and promoting transparency within the insurance process.

Contention

While proponents argue that HB3017 enhances patient rights and improves the healthcare experience by making insurance more accessible and equitable, there are concerns about the legislation's operational implications for health maintenance organizations and insurers. Some industry representatives have discussed the potential for increased litigation and disputes surrounding claims adjudication as a consequence of removing discretionary clauses. This could lead to rising costs for insurers, which may translate into higher premiums for consumers in the long run. The debate surrounding the bill reflects a broader conflict between consumer protection and business operational flexibility.

Companion Bills

No companion bills found.

Previously Filed As

TX HB3091

Relating to identification cards issued by health maintenance organizations and preferred provider organizations.

TX HB2414

Relating to certain practices of a health maintenance organization or insurer to encourage the use of certain physicians and health care providers.

TX HB895

Relating to the use of extrapolation by a health maintenance organization or an insurer to audit claims.

TX SB1141

Relating to the use of extrapolation by a health maintenance organization or an insurer to audit claims.

TX HB4067

Relating to examinations of health maintenance organizations and insurers by the commissioner of insurance regarding compliance with certain utilization review and preauthorization requirements; authorizing a fee.

TX HB4367

Relating to the preauthorization of medical or health care services by a health maintenance organization or an insurer.

TX HB1239

Relating to consideration by insurers of certain prohibited criteria for ratemaking and coverage decisions and the use of disparate impact analysis regarding certain insurance practices.

TX HB619

Relating to an insurance premium tax credit for contributions made to certain educational assistance organizations.

TX HB1129

Relating to the creation of a health insurance risk pool for certain health benefit plan enrollees; authorizing an assessment.

TX SB1623

Relating to the coverage and provision of abortion and contraception under a health benefit plan and certain programs administered by this state.

Similar Bills

No similar bills found.