Texas 2009 - 81st Regular

Texas Senate Bill SB1156 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R7741 AJA-D
2	2	By: Davis, Wendy S.B. No. 1156
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to reporting of medical loss ratios by health benefit plan
8	8	issuers.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1223 to read as follows:
12	12	CHAPTER 1223. MEDICAL LOSS RATIO AND HEALTH BENEFIT PLAN PREMIUMS
13	13	Sec. 1223.001. DEFINITIONS. In this chapter:
14	14	(1) "Direct losses incurred" means the sum of direct
15	15	losses paid plus an estimate of losses to be paid in the future for
16	16	all claims arising from the current reporting period and all prior
17	17	periods, minus the corresponding estimate made at the close of
18	18	business for the preceding period. This amount does not include
19	19	home office and overhead costs, advertising costs, commissions and
20	20	other acquisition costs, taxes, capital costs, administrative
21	21	costs, utilization review costs, or claims processing costs.
22	22	(2) "Direct losses paid" means the sum of all payments
23	23	made during the period for claimants under a health benefit plan
24	24	before reinsurance has been ceded or assumed. This amount does not
25	25	include home office and overhead costs, advertising costs,
26	26	commissions and other acquisition costs, taxes, capital costs,
27	27	administrative costs, utilization review costs, or claims
28	28	processing costs.
29	29	(3) "Direct premiums earned" means the amount of
30	30	premium attributable to the coverage already provided in a given
31	31	period before reinsurance has been ceded or assumed.
32	32	(4) "Medical loss ratio" means direct losses incurred
33	33	divided by direct premiums earned.
34	34	Sec. 1223.002. APPLICABILITY OF CHAPTER. (a) This chapter
35	35	applies to the issuer of a health benefit plan that provides
36	36	benefits for medical or surgical expenses incurred as a result of a
37	37	health condition, accident, or sickness, including an individual,
38	38	group, blanket, or franchise insurance policy or insurance
39	39	agreement, a group hospital service contract, or an individual or
40	40	group evidence of coverage or similar coverage document that is
41	41	offered by:
42	42	(1) an insurance company;
43	43	(2) a group hospital service corporation operating
44	44	under Chapter 842;
45	45	(3) a fraternal benefit society operating under
46	46	Chapter 885;
47	47	(4) a stipulated premium company operating under
48	48	Chapter 884;
49	49	(5) an exchange operating under Chapter 942;
50	50	(6) a health maintenance organization operating under
51	51	Chapter 843;
52	52	(7) a multiple employer welfare arrangement that holds
53	53	a certificate of authority under Chapter 846; or
54	54	(8) an approved nonprofit health corporation that
55	55	holds a certificate of authority under Chapter 844.
56	56	(b) Notwithstanding any provision in Chapter 1551, 1575,
57	57	1579, or 1601 or any other law, this chapter applies to a health
58	58	benefit plan issuer with respect to:
59	59	(1) a basic coverage plan under Chapter 1551;
60	60	(2) a basic plan under Chapter 1575;
61	61	(3) a primary care coverage plan under Chapter 1579;
62	62	and
63	63	(4) basic coverage under Chapter 1601.
64	64	(c) Notwithstanding any other law, this chapter applies to a
65	65	health benefit plan issuer with respect to a standard health
66	66	benefit plan provided under Chapter 1507.
67	67	(d) Notwithstanding Section 1501.251 or any other law, this
68	68	chapter applies to a health benefit plan issuer with respect to
69	69	coverage under a small employer health benefit plan subject to
70	70	Chapter 1501.
71	71	Sec. 1223.003. EXCEPTION. This chapter does not apply with
72	72	respect to:
73	73	(1) a plan that provides coverage:
74	74	(A) for wages or payments in lieu of wages for a
75	75	period during which an employee is absent from work because of
76	76	sickness or injury;
77	77	(B) as a supplement to a liability insurance
78	78	policy;
79	79	(C) for credit insurance;
80	80	(D) only for dental or vision care;
81	81	(E) only for hospital expenses; or
82	82	(F) only for indemnity for hospital confinement;
83	83	(2) a Medicare supplemental policy as defined by
84	84	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
85	85	(3) a workers' compensation insurance policy; or
86	86	(4) medical payment insurance coverage provided under
87	87	a motor vehicle insurance policy.
88	88	Sec. 1223.004. MEDICAL LOSS RATIO REPORTING. The
89	89	commissioner by rule shall require each health benefit plan issuer
90	90	to report at least annually the health benefit plan issuer's
91	91	medical loss ratio for the preceding year for each health benefit
92	92	plan issued.
93	93	SECTION 2. This Act takes effect September 1, 2009.