Texas 2009 - 81st Regular

Texas House Bill HB2453 Compare Versions

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1	1	81R24605 PMO-F
2	2	By: Eiland H.B. No. 2453
3	3	Substitute the following for H.B. No. 2453:
4	4	By: Eiland C.S.H.B. No. 2453
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to the availability and continuation of certain health
10	10	benefit plan coverage.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
13	13	by adding Chapter 1202A to read as follows:
14	14	CHAPTER 1202A. TEMPORARY EXTENSION OF ELECTION PERIOD FOR
15	15	CONTINUATION OF CERTAIN COVERAGE
16	16	Sec. 1202A.001. EXTENSION OF ELECTION PERIOD. (a) For the
17	17	purposes of this section, an "extended election eligible
18	18	individual" means an employee, member, dependent, or enrollee:
19	19	(1) who became eligible for continuation coverage due
20	20	to involuntary termination, other than involuntary termination for
21	21	cause, under Subchapter F, Chapter 1251, or Subchapter G, Chapter
22	22	1271, at any time during the period that begins on September 1,
23	23	2008, and ends on February 16, 2009;
24	24	(2) who did not elect such coverage or whose elected
25	25	continuation coverage lapsed or was canceled without reinstatement
26	26	for a reason other than exhaustion of the maximum period of
27	27	continuation coverage allowable under law; and
28	28	(3) whose involuntary termination on which the
29	29	eligibility is based occurred during that same period.
30	30	(b) Notwithstanding Section 1251.253 or 1271.301, an
31	31	extended election eligible individual may elect continuation
32	32	coverage under this section beginning on the effective date of this
33	33	Act and ending on the 60th day after the date on which the
34	34	notification required by Subsection (e) is provided to the
35	35	individual.
36	36	(c) The period of continuation coverage for an extended
37	37	election eligible individual who elects continuation coverage
38	38	begins with the first period of coverage beginning on or after the
39	39	effective date of Senate Bill 1771, Acts of the 81st Legislature,
40	40	Regular Session, 2009, and does not extend beyond the date the
41	41	period of continuation coverage would have ended if the coverage
42	42	had been elected during the election period required under the law
43	43	as it existed before the effective date of Senate Bill 1771, Acts of
44	44	the 81st Legislature, Regular Session, 2009.
45	45	(d) With respect to an individual who elects continuation
46	46	coverage under Subsection (b), the period beginning on the date the
47	47	individual first became eligible for continuation coverage and
48	48	ending on the first day of the 60-day election period described by
49	49	Subsection (b) shall be disregarded for purposes of determining a
50	50	63-day period referred to in 29 U.S.C. Section 1181(c)(2), 42
51	51	U.S.C. Section 300gg(c)(2), 26 U.S.C. Section 9801(c)(2), and
52	52	Sections 846.202(d), 1501.102, and 1506.001(8).
53	53	(e) Not later than the 60th day after the effective date of
54	54	Senate Bill 1771, Acts of the 81st Legislature, Regular Session,
55	55	2009, an employer or group policy or contract holder shall provide
56	56	notice to any former employee, member, dependent, or enrollee who
57	57	is an extended election eligible individual that includes:
58	58	(1) a description of the extended election period
59	59	available to the individual under this section;
60	60	(2) a description, displayed in a prominent manner, of
61	61	the individual's right to a reduced premium and any conditions on
62	62	entitlement to the reduced premium under the American Recovery and
63	63	Reinvestment Act of 2009;
64	64	(3) a form that allows the individual to request
65	65	treatment as an assistance eligible individual, as defined by the
66	66	American Recovery and Reinvestment Act of 2009, to whom the premium
67	67	subsidy would apply;
68	68	(4) the amount continuation coverage will cost and the
69	69	period of coverage available;
70	70	(5) an election form that includes the return address
71	71	and the due date for making the election; and
72	72	(6) notice that if the individual is entitled to the
73	73	reduced premium and later becomes eligible for other group health
74	74	plan coverage or Medicare, the individual must notify the employer
75	75	in writing or the individual may be subject to a tax penalty.
76	76	Sec. 1202A.002. EXPIRATION OF CHAPTER. This chapter
77	77	expires September 1, 2013.
78	78	SECTION 2. Section 1251.253, Insurance Code, is amended to
79	79	read as follows:
80	80	Sec. 1251.253. REQUEST FOR CONTINUATION OF GROUP COVERAGE.
81	81	An employee, member, or dependent must provide to the employer or
82	82	group policyholder a written request for [in writing the]
83	83	continuation of group coverage not later than the 60th [31st] day
84	84	after the later of:
85	85	(1) the date the group coverage would otherwise
86	86	terminate; or
87	87	(2) the date the individual is given, in a format
88	88	prescribed by the commissioner, notice by either the employer or
89	89	the group policyholder of the right to continuation of group
90	90	coverage.
91	91	SECTION 3. Section 1251.254, Insurance Code, is amended to
92	92	read as follows:
93	93	Sec. 1251.254. PAYMENT OF CONTRIBUTIONS. Except as
94	94	provided by this section, an [(a) An] employee, member, or
95	95	dependent who elects to continue group coverage under this
96	96	subchapter must pay to the employer or group policyholder[,] each
97	97	month [in advance,] the amount of contribution required by the
98	98	employer or policyholder, plus two percent of the group rate for the
99	99	coverage being continued under the group policy [on the due date of
100	100	each payment]. A payment under this section must be made not later
101	101	than the 45th day after the date of the initial election for
102	102	coverage and on the due date of each payment thereafter. Following
103	103	the first payment made after the initial election for coverage, the
104	104	payment of any other premium shall be considered timely if made on
105	105	or before the 30th day after the date on which the payment is due.
106	106	[(b) The employee's, member's, or dependent's written
107	107	election for continuation of group coverage, together with the
108	108	first contribution required to establish advance monthly
109	109	contributions, must be given to the employer or policyholder not
110	110	later than the later of:
111	111	[(1) the 31st day after the date coverage would
112	112	otherwise terminate; or
113	113	[(2) the date the individual is given notice by either
114	114	the employer or the group policyholder of the right to continuation
115	115	of group coverage.]
116	116	SECTION 4. Section 1251.255, Insurance Code, is amended to
117	117	read as follows:
118	118	Sec. 1251.255. TERMINATION OF CONTINUED COVERAGE. (a)
119	119	Group coverage continued under this subchapter may not terminate
120	120	until the earliest of:
121	121	(1) the date the maximum continuation period provided
122	122	by law would end, which is:
123	123	(A) for any employee, member, or dependent not
124	124	eligible for continuation coverage under Title X, Consolidated
125	125	Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161
126	126	et seq.) (COBRA), nine [six] months after the date the employee,
127	127	member, or dependent elects to continue the group coverage; or
128	128	(B) for any employee, member, or dependent
129	129	eligible for continuation coverage under COBRA, six additional
130	130	months following any period of continuation coverage provided under
131	131	COBRA;
132	132	(2) the date failure to make timely payments would
133	133	terminate the group coverage;
134	134	(3) the date the group coverage terminates in its
135	135	entirety;
136	136	(4) the date the insured is or could be covered under
137	137	Medicare;
138	138	(5) the date the insured is covered for similar
139	139	benefits by another plan or program, including:
140	140	(A) a hospital, surgical, medical, or major
141	141	medical expense insurance policy;
142	142	(B) a hospital or medical service subscriber
143	143	contract; or
144	144	(C) a medical practice or other prepayment plan;
145	145	(6) the date the insured is eligible for similar
146	146	benefits, whether or not covered for those benefits, under any
147	147	arrangement of coverage for individuals in a group, whether on an
148	148	insured or uninsured basis; or
149	149	(7) the date similar benefits are provided or
150	150	available to the insured under any state or federal law other than
151	151	continuation coverage under Title X, Consolidated Omnibus Budget
152	152	Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)
153	153	(COBRA).
154	154	(b) Not later than the 30th day before the end of the
155	155	continuation period described by Subsection (a)(1) that is
156	156	applicable to the individual [six months after the date the
157	157	employee, member, or dependent elects to continue group coverage
158	158	under the policy], the insurer shall:
159	159	(1) notify the individual that the individual may be
160	160	eligible for coverage under the Texas Health Insurance Risk Pool as
161	161	provided by Chapter 1506; and
162	162	(2) provide to the individual the address for applying
163	163	to that pool.
164	164	SECTION 5. Section 1271.302, Insurance Code, is amended to
165	165	read as follows:
166	166	Sec. 1271.302. REQUEST FOR CONTINUED COVERAGE; DEADLINE.
167	167	An enrollee must provide to the employer or group contract holder
168	168	[make] a written notice of election to continue group coverage
169	169	under this subchapter [and pay the first contribution required to
170	170	establish contributions on an advance monthly basis to the employer
171	171	or group contract holder] not later than the 60th [31st] day after
172	172	the later of:
173	173	(1) the date the group coverage would otherwise
174	174	terminate; or
175	175	(2) the date the enrollee is given notice of the right
176	176	of continuation by the employer or group contract holder.
177	177	SECTION 6. Section 1271.303(b), Insurance Code, is amended
178	178	to read as follows:
179	179	(b) The enrollee must make the payment not later than the
180	180	45th day after the initial election for coverage and on the due date
181	181	of each payment thereafter. Following the first payment made after
182	182	the initial election for coverage, the payment of any other premium
183	183	shall be considered timely if made by the 30th day after the date on
184	184	which payment is due [in advance on a monthly basis on the due date
185	185	of each payment].
186	186	SECTION 7. Section 1271.304, Insurance Code, is amended to
187	187	read as follows:
188	188	Sec. 1271.304. TERMINATION OF CONTINUED COVERAGE. Group
189	189	continued coverage under this subchapter may not terminate until
190	190	the earliest of:
191	191	(1) the date the maximum continuation period provided
192	192	by law would end, which is:
193	193	(A) for any enrollee not eligible for
194	194	continuation coverage under Title X, Consolidated Omnibus Budget
195	195	Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)
196	196	(COBRA), the end of the nine-month [six-month] period after the
197	197	date the election to continue coverage is made; or
198	198	(B) for any enrollee eligible for continuation
199	199	coverage under COBRA, six additional months following any period of
200	200	continuation provided under that statute;
201	201	(2) the date on which failure to make timely payments
202	202	terminates coverage;
203	203	(3) the date on which the enrollee is covered for
204	204	similar services and benefits by any other plan or program,
205	205	including a hospital, surgical, medical, or major medical expense
206	206	insurance policy, hospital or medical service subscriber contract,
207	207	or medical practice or other prepayment plan; or
208	208	(4) the date on which the group coverage terminates in
209	209	its entirety.
210	210	SECTION 8. Section 1271.305(a), Insurance Code, is amended
211	211	to read as follows:
212	212	(a) At least 30 days before the end of the continuation
213	213	[six-month] period described by Section 1271.304(1) that is
214	214	applicable to the enrollee [after the date an enrollee elects to
215	215	continue group coverage], the health maintenance organization
216	216	shall notify the enrollee that the enrollee may be eligible for
217	217	coverage under the Texas Health Insurance Risk Pool as provided by
218	218	Chapter 1506.
219	219	SECTION 9. Section 1506.153, Insurance Code, is amended by
220	220	adding Subsections (c) and (d) to read as follows:
221	221	(c) An individual eligible for benefits from the
222	222	continuation of coverage under Subchapter F or G, Chapter 1251, or
223	223	Subchapter G, Chapter 1271, who did not elect continuation coverage
224	224	during the election period, or whose elected continuation coverage
225	225	lapsed or was canceled without reinstatement, is eligible for pool
226	226	coverage. Eligibility under this subsection is subject to a
227	227	180-day exclusion of coverage under Section 1506.155(a-1).
228	228	(d) The 180-day exclusion of coverage provided under
229	229	Subsection (c) does not apply to an individual eligible for
230	230	benefits from the continuation of coverage under Subchapter F or G,
231	231	Chapter 1251, or Subchapter G, Chapter 1271, who did not elect
232	232	continuation coverage during the election period, or whose elected
233	233	continuation coverage lapsed or was canceled without
234	234	reinstatement, following a period of continuation coverage under
235	235	Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29
236	236	U.S.C. Section 1161 et seq.) (COBRA).
237	237	SECTION 10. Section 1506.155(a-1), Insurance Code, is
238	238	amended to read as follows:
239	239	(a-1) Except as provided by Section 1506.056, pool coverage
240	240	for an individual eligible pursuant to Section 1506.153(b) or (c)
241	241	excludes charges or expenses incurred before the expiration of 180
242	242	days from the effective date of coverage with regard to any
243	243	condition for which:
244	244	(1) the existence of symptoms would cause an
245	245	ordinarily prudent person to seek diagnosis, care, or treatment
246	246	within the six-month period preceding the effective date of
247	247	coverage; or
248	248	(2) medical advice, care, or treatment was recommended
249	249	or received during the six-month period preceding the effective
250	250	date of coverage.
251	251	SECTION 11. (a) Sections 1251.253 and 1271.302, Insurance
252	252	Code, as amended by this Act, apply only to:
253	253	(1) a request for continuation of group coverage that
254	254	an employee, member, dependent, or enrollee becomes eligible to
255	255	make on or after the effective date of this Act; or
256	256	(2) a request for continuation of group coverage that
257	257	an employee, member, dependent, or enrollee became eligible to make
258	258	before the effective date of this Act, provided that the election
259	259	period available to the employee, member, dependent, or enrollee
260	260	under Section 1251.253 or 1271.302, Insurance Code, as those
261	261	sections existed before amendment by this Act, has not expired as of
262	262	the effective date of this Act.
263	263	(b) A request for continuation of group coverage that an
264	264	employee, member, dependent, or enrollee became eligible to make
265	265	before the effective date of this Act and that, on the effective
266	266	date of this Act, the employee, member, dependent, or enrollee is no
267	267	longer eligible to make, is governed by the law as it existed before
268	268	the effective date of this Act, and that law is continued in effect
269	269	for that purpose. This subsection does not apply to an employee,
270	270	member, dependent, or enrollee who is an extended election eligible
271	271	individual to whom Chapter 1202A, Insurance Code, as added by this
272	272	Act, applies.
273	273	SECTION 12. Sections 1251.254 and 1271.303, Insurance Code,
274	274	as amended by this Act, apply only to a payment for continuation
275	275	coverage required to be made on or after the effective date of this
276	276	Act. A payment for continuation coverage required to be made before
277	277	the effective date of this Act is governed by the law as it existed
278	278	before that date, and that law is continued in effect for that
279	279	purpose.
280	280	SECTION 13. Sections 1251.255 and 1271.304, Insurance Code,
281	281	as amended by this Act, apply to coverage for which an election to
282	282	continue was made on or after the effective date of this Act.
283	283	SECTION 14. This Act takes effect immediately if it
284	284	receives a vote of two-thirds of all the members elected to each
285	285	house, as provided by Section 39, Article III, Texas Constitution.
286	286	If this Act does not receive the vote necessary for immediate
287	287	effect, this Act takes effect September 1, 2009.