Texas 2009 - 81st Regular

Texas Senate Bill SB1403 Compare Versions

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1	1	S.B. No. 1403
2	2
3	3
4	4	AN ACT
5	5	relating to changing the Texas Health Insurance Risk Pool to the
6	6	Texas Health Insurance Pool, and to the operation of that pool.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. The heading to Chapter 1506, Insurance Code, is
9	9	amended to read as follows:
10	10	CHAPTER 1506. TEXAS HEALTH INSURANCE [RISK] POOL
11	11	SECTION 2. Subdivision (7), Section 1506.001, Insurance
12	12	Code, is amended to read as follows:
13	13	(7) "Pool" means the Texas Health Insurance [Risk]
14	14	Pool.
15	15	SECTION 3. Subchapter A, Chapter 1506, Insurance Code, is
16	16	amended by adding Section 1506.010 to read as follows:
17	17	Sec. 1506.010. REDESIGNATION. Effective September 1, 2009,
18	18	the Texas Health Insurance Risk Pool is redesignated the Texas
19	19	Health Insurance Pool. A reference in any law to the Texas Health
20	20	Insurance Risk Pool means the Texas Health Insurance Pool.
21	21	SECTION 4. Section 1506.152, Insurance Code, is amended by
22	22	amending Subsections (b) and (c) and adding Subsection (f) to read
23	23	as follows:
24	24	(b) Subject to Subsection (f), each [Each] dependent of an
25	25	individual who is eligible for coverage from the pool is also
26	26	eligible for coverage from the pool.
27	27	(c) Subject to Subsection (f), if [If] an individual who
28	28	obtains coverage from the pool under Subsection (a) is a child, each
29	29	parent, grandparent, brother, sister, or child of that individual
30	30	who resides with that individual is also eligible for coverage from
31	31	the pool.
32	32	(f) A dependent or individual described by Subsection (c)
33	33	who is not a federally defined eligible individual and who has not
34	34	experienced a significant break in coverage may not obtain coverage
35	35	from the pool before the first date on which the dependent or
36	36	individual has been:
37	37	(1) a legally domiciled resident of this state for at
38	38	least the 30 days preceding the date of the application for coverage
39	39	from the pool; and
40	40	(2) a citizen or permanent resident of the United
41	41	States for at least three continuous years.
42	42	SECTION 5. Section 1506.153, Insurance Code, as amended by
43	43	Chapters 808 (S.B. 1254), 881 (H.B. 1977), and 1070 (H.B. 2548),
44	44	Acts of the 80th Legislature, Regular Session, 2007, is reenacted
45	45	and amended to read as follows:
46	46	Sec. 1506.153. INELIGIBILITY FOR COVERAGE. (a) Notwithstanding
47	47	Section 1506.152 [Section 1506.152(a)-(c)], an individual is not
48	48	eligible for coverage from the pool if:
49	49	(1) on the date pool coverage is to take effect, the
50	50	individual has health benefit plan coverage from a health benefit
51	51	plan issuer or health benefit arrangement in effect, except as
52	52	provided by Section 1506.152(a)(3)(E);
53	53	(2) at the time the individual applies to the pool,
54	54	except as provided in Subsection (b), the individual is eligible
55	55	for other health care benefits, including an offer of benefits from
56	56	the continuation of coverage under Title X, Consolidated Omnibus
57	57	Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et
58	58	seq.)[, as amended] (COBRA), other than:
59	59	(A) coverage, including COBRA or other
60	60	continuation coverage or conversion coverage, maintained for any
61	61	preexisting condition waiting period under a pool policy or during
62	62	any preexisting condition waiting period or other waiting period of
63	63	the other coverage;
64	64	(B) employer group coverage conditioned by a
65	65	limitation of the kind described by Section 1506.152(a)(3)(A) or
66	66	(C); or
67	67	(C) individual coverage conditioned by a
68	68	limitation described by Section 1506.152(a)(3)(C) or (D);
69	69	(3) within 12 months before the date the individual
70	70	applies to the pool, the individual terminated coverage in the
71	71	pool, unless the individual:
72	72	(A) demonstrates a good faith reason for the
73	73	termination; or
74	74	(B) is a federally defined eligible individual;
75	75	(4) the individual is confined in a county jail or
76	76	imprisoned in a state or federal prison;
77	77	(5) any of the individual's premiums are paid for or
78	78	reimbursed under a government-sponsored program or by a government
79	79	agency or health care provider;
80	80	(6) the individual's prior coverage with the pool was
81	81	terminated:
82	82	(A) during the 12-month period preceding the date
83	83	of application for nonpayment of premiums; or
84	84	(B) for fraud; or
85	85	(7) the individual is eligible for health benefit plan
86	86	coverage provided in connection with a policy, plan, or program
87	87	paid for or sponsored by an employer, even though the employer
88	88	coverage is declined. This subdivision does not apply to an
89	89	individual who is a part-time employee or a part-time employee's
90	90	dependent eligible to participate in an employer plan that provides
91	91	health benefit coverage:
92	92	(A) that is more limited or restricted than
93	93	coverage with the pool; and
94	94	(B) for which there is no employer contribution
95	95	to the premium, either directly or indirectly.
96	96	(b) An individual eligible for benefits from the
97	97	continuation of coverage under Title X, Consolidated Omnibus Budget
98	98	Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)[, as
99	99	amended] (COBRA), or a comparable federal or state employee
100	100	coverage continuation program, who did not elect continuation of
101	101	coverage during the election period, or whose elected continuation
102	102	of coverage lapsed or was cancelled without reinstatement, is
103	103	eligible for pool coverage. Eligibility under this subsection is
104	104	subject to a minimum 180-day exclusion of coverage under Section
105	105	1506.155(a-1).
106	106	SECTION 6. Section 1506.155, Insurance Code, is amended by
107	107	amending Subsection (a-1) and adding Subsection (c-1) to read as
108	108	follows:
109	109	(a-1) Except as provided by Section 1506.056, pool coverage
110	110	for an individual eligible pursuant to Section 1506.153(b) excludes
111	111	charges or expenses incurred before the first anniversary of [the
112	112	expiration of 180 days from] the effective date of coverage with
113	113	regard to any condition for which:
114	114	(1) the existence of symptoms would cause an
115	115	ordinarily prudent person to seek diagnosis, care, or treatment
116	116	within the six-month period preceding the effective date of
117	117	coverage; or
118	118	(2) medical advice, care, or treatment was recommended
119	119	or received during the six-month period preceding the effective
120	120	date of coverage.
121	121	(c-1) If an individual eligible under Section 1506.153(b)
122	122	was covered by creditable coverage at any time during the 12-month
123	123	period immediately preceding the effective date of the individual's
124	124	coverage under the pool, the pool shall subtract from the exclusion
125	125	period required under Subsection (a-1) up to 180 days of:
126	126	(1) the period during which the individual was
127	127	covered under the creditable coverage; and
128	128	(2) any waiting period that applied before the
129	129	creditable coverage became effective.
130	130	SECTION 7. Subsection (b), Section 1506.2523, Insurance
131	131	Code, is amended to read as follows:
132	132	(b) For purposes of this section, gross health benefit plan
133	133	premiums do not include premiums collected for:
134	134	(1) coverage under a Medicare supplement benefit plan
135	135	subject to Chapter 1652;
136	136	(2) coverage under a small employer health benefit
137	137	plan subject to Subchapters A-H, Chapter 1501; or
138	138	(3) coverage or insurance listed in Section
139	139	1506.002(b), (c), or (d).
140	140	SECTION 8. This Act applies only to an application for
141	141	initial or renewal coverage through the Texas Health Insurance Risk
142	142	Pool under Chapter 1506, Insurance Code, as amended by this Act,
143	143	that is filed with the pool on or after January 1, 2010. An
144	144	application filed before that date is governed by the law in effect
145	145	on the date on which the application was filed, and the former law
146	146	is continued in effect for that purpose.
147	147	SECTION 9. This Act takes effect September 1, 2009.
148	148	______________________________ ______________________________
149	149	President of the Senate Speaker of the House
150	150	I hereby certify that S.B. No. 1403 passed the Senate on
151	151	April 9, 2009, by the following vote: Yeas 31, Nays 0.
152	152	______________________________
153	153	Secretary of the Senate
154	154	I hereby certify that S.B. No. 1403 passed the House on
155	155	May 26, 2009, by the following vote: Yeas 144, Nays 0, one
156	156	present not voting.
157	157	______________________________
158	158	Chief Clerk of the House
159	159	Approved:
160	160	______________________________
161	161	Date
162	162	______________________________
163	163	Governor