| 1 | 1 | | 81R7523 PB-F |
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| 2 | 2 | | By: Rodriguez H.B. No. 1370 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to the use of certain insurance policy forms in connection |
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| 8 | 8 | | with a preferred provider benefit plan. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Section 1701.001, Insurance Code, is amended to |
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| 11 | 11 | | read as follows: |
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| 12 | 12 | | Sec. 1701.001. DEFINITIONS [DEFINITION]. In this chapter: |
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| 13 | 13 | | (1) "Nonparticipating physician or health care |
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| 14 | 14 | | provider" means a physician or other health care provider who is not |
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| 15 | 15 | | a party under a contract to provide health care services through a |
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| 16 | 16 | | provider network. |
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| 17 | 17 | | (2) "Provider network" means a health benefit plan |
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| 18 | 18 | | issued by a preferred provider benefit plan issuer: |
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| 19 | 19 | | (A) under which health care services are provided |
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| 20 | 20 | | to enrollees in the plan through contracts with physicians and |
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| 21 | 21 | | other health care providers; and |
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| 22 | 22 | | (B) that requires those enrollees to use |
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| 23 | 23 | | physicians and other health care providers participating in the |
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| 24 | 24 | | plan and procedures covered by the plan for a different level of |
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| 25 | 25 | | coverage. |
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| 26 | 26 | | (3) "Use" [, "use"] includes issue and deliver. |
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| 27 | 27 | | SECTION 2. Section 1701.055, Insurance Code, is amended by |
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| 28 | 28 | | adding Subsections (f) and (g) to read as follows: |
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| 29 | 29 | | (f) Notwithstanding Section 1301.003, the commissioner |
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| 30 | 30 | | shall find a policy form filed by an insurer for a preferred |
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| 31 | 31 | | provider benefit plan to be unjust and deceptive if the form does |
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| 32 | 32 | | not contain a provision that computes the enrollee's coinsurance |
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| 33 | 33 | | for health care services otherwise available under the plan that |
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| 34 | 34 | | are provided by nonparticipating physicians or health care |
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| 35 | 35 | | providers based on the billed charge of the nonparticipating |
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| 36 | 36 | | physician or health care provider. |
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| 37 | 37 | | (g) If the commissioner determines that use of a form that |
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| 38 | 38 | | does not comply with Subsection (f) poses an imminent threat to the |
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| 39 | 39 | | health, safety, or welfare of the residents of this state, the |
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| 40 | 40 | | commissioner may by order withdraw approval of the form under this |
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| 41 | 41 | | section without notice and hearing. The insurer shall cease using |
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| 42 | 42 | | the form immediately on receipt of notice of the order. |
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| 43 | 43 | | SECTION 3. This Act takes effect immediately if it receives |
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| 44 | 44 | | a vote of two-thirds of all the members elected to each house, as |
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| 45 | 45 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 46 | 46 | | Act does not receive the vote necessary for immediate effect, this |
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| 47 | 47 | | Act takes effect September 1, 2009. |
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