81R6165 PB-D
By: Thompson H.B. No. 3183
A BILL TO BE ENTITLED
AN ACT
relating to requirements regarding employer liability for certain
group health benefit plan premiums.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.210, Insurance Code, is amended to
read as follows:
Sec. 843.210. TERMS OF ENROLLEE ELIGIBILITY. (a) A
contract between a health maintenance organization and a group
contract holder must provide that:
(1) in addition to any other premiums for which the
group contract holder is liable, the group contract holder is
liable for an enrollee's premiums from the time the enrollee is no
longer part of the group eligible for coverage under the contract
until the end of the month in which the contract holder notifies the
health maintenance organization that the enrollee is no longer part
of the group eligible for coverage by the contract; and
(2) the enrollee remains covered by the contract until
the end of that period.
(b) Each health maintenance organization that enters into a
contract described by Subsection (a) shall notify the group
contract holder periodically as provided by this section that the
contract holder is liable for premiums on an enrollee who is no
longer part of the group eligible for coverage under the contract
until the health maintenance organization receives notification of
termination of the enrollee's eligibility for that coverage.
(c) If the health maintenance organization charges the
group contract holder on a monthly basis for the coverage premiums,
the health maintenance organization shall include the notice
required by Subsection (b) in each monthly statement sent to the
group contract holder. If the health maintenance organization
charges the group contract holder on other than a monthly basis for
the premiums, the health maintenance organization shall notify the
group contract holder periodically in the manner prescribed by the
commissioner by rule.
(d) The notice required by Subsection (b) must include a
description of methods preferred by the health maintenance
organization for notification by a group contract holder of an
enrollee's termination from coverage eligibility.
SECTION 2. Section 1301.0061, Insurance Code, is amended to
read as follows:
Sec. 1301.0061. TERMS OF ENROLLEE ELIGIBILITY. (a) A
contract between an insurer and a group policyholder under a
preferred provider benefit plan must provide that:
(1) in addition to any other premiums for which the
group policyholder is liable, the group policyholder is liable for
an individual insured's premiums from the time the individual is no
longer part of the group eligible for coverage under the policy
until the end of the month in which the policyholder notifies the
insurer that the individual is no longer part of the group eligible
for coverage under the policy; and
(2) the individual remains covered under the policy
until the end of that period.
(b) Each insurer that enters into a contract described by
Subsection (a) shall notify the group policyholder periodically as
provided by this section that the policyholder is liable for
premiums on an individual who is no longer part of the group
eligible for coverage until the insurer receives notification of
termination of the individual's eligibility for coverage.
(c) If the insurer charges the group policyholder on a
monthly basis for the premiums, the insurer shall include the
notice required by Subsection (b) in each monthly statement sent to
the group policyholder. If the insurer charges the group
policyholder on other than a monthly basis for the premiums, the
insurer shall notify the group policyholder periodically in the
manner prescribed by the commissioner by rule.
(d) The notice required by Subsection (b) must include a
description of methods preferred by the insurer for notification by
a group policyholder of an individual's termination from coverage
eligibility.
SECTION 3. The change in law made by this Act applies only
to a contract between an insurer or health maintenance organization
and a group policy or contract holder that is entered into or
renewed on or after January 1, 2010. A contract entered into or
renewed before January 1, 2010, is governed by the law in effect
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2009.