81R7523 PB-F
By: Rodriguez H.B. No. 1370
A BILL TO BE ENTITLED
AN ACT
relating to the use of certain insurance policy forms in connection
with a preferred provider benefit plan.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1701.001, Insurance Code, is amended to
read as follows:
Sec. 1701.001. DEFINITIONS [DEFINITION]. In this chapter:
(1) "Nonparticipating physician or health care
provider" means a physician or other health care provider who is not
a party under a contract to provide health care services through a
provider network.
(2) "Provider network" means a health benefit plan
issued by a preferred provider benefit plan issuer:
(A) under which health care services are provided
to enrollees in the plan through contracts with physicians and
other health care providers; and
(B) that requires those enrollees to use
physicians and other health care providers participating in the
plan and procedures covered by the plan for a different level of
coverage.
(3) "Use" [, "use"] includes issue and deliver.
SECTION 2. Section 1701.055, Insurance Code, is amended by
adding Subsections (f) and (g) to read as follows:
(f) Notwithstanding Section 1301.003, the commissioner
shall find a policy form filed by an insurer for a preferred
provider benefit plan to be unjust and deceptive if the form does
not contain a provision that computes the enrollee's coinsurance
for health care services otherwise available under the plan that
are provided by nonparticipating physicians or health care
providers based on the billed charge of the nonparticipating
physician or health care provider.
(g) If the commissioner determines that use of a form that
does not comply with Subsection (f) poses an imminent threat to the
health, safety, or welfare of the residents of this state, the
commissioner may by order withdraw approval of the form under this
section without notice and hearing. The insurer shall cease using
the form immediately on receipt of notice of the order.
SECTION 3. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.