S.B. No. 1403
AN ACT
relating to changing the Texas Health Insurance Risk Pool to the
Texas Health Insurance Pool, and to the operation of that pool.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 1506, Insurance Code, is
amended to read as follows:
CHAPTER 1506. TEXAS HEALTH INSURANCE [RISK] POOL
SECTION 2. Subdivision (7), Section 1506.001, Insurance
Code, is amended to read as follows:
(7) "Pool" means the Texas Health Insurance [Risk]
Pool.
SECTION 3. Subchapter A, Chapter 1506, Insurance Code, is
amended by adding Section 1506.010 to read as follows:
Sec. 1506.010. REDESIGNATION. Effective September 1, 2009,
the Texas Health Insurance Risk Pool is redesignated the Texas
Health Insurance Pool. A reference in any law to the Texas Health
Insurance Risk Pool means the Texas Health Insurance Pool.
SECTION 4. Section 1506.152, Insurance Code, is amended by
amending Subsections (b) and (c) and adding Subsection (f) to read
as follows:
(b) Subject to Subsection (f), each [Each] dependent of an
individual who is eligible for coverage from the pool is also
eligible for coverage from the pool.
(c) Subject to Subsection (f), if [If] an individual who
obtains coverage from the pool under Subsection (a) is a child, each
parent, grandparent, brother, sister, or child of that individual
who resides with that individual is also eligible for coverage from
the pool.
(f) A dependent or individual described by Subsection (c)
who is not a federally defined eligible individual and who has not
experienced a significant break in coverage may not obtain coverage
from the pool before the first date on which the dependent or
individual has been:
(1) a legally domiciled resident of this state for at
least the 30 days preceding the date of the application for coverage
from the pool; and
(2) a citizen or permanent resident of the United
States for at least three continuous years.
SECTION 5. Section 1506.153, Insurance Code, as amended by
Chapters 808 (S.B. 1254), 881 (H.B. 1977), and 1070 (H.B. 2548),
Acts of the 80th Legislature, Regular Session, 2007, is reenacted
and amended to read as follows:
Sec. 1506.153. INELIGIBILITY FOR COVERAGE. (a) Notwithstanding
Section 1506.152 [Section 1506.152(a)-(c)], an individual is not
eligible for coverage from the pool if:
(1) on the date pool coverage is to take effect, the
individual has health benefit plan coverage from a health benefit
plan issuer or health benefit arrangement in effect, except as
provided by Section 1506.152(a)(3)(E);
(2) at the time the individual applies to the pool,
except as provided in Subsection (b), the individual is eligible
for other health care benefits, including an offer of benefits from
the continuation of coverage under Title X, Consolidated Omnibus
Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et
seq.)[, as amended] (COBRA), other than:
(A) coverage, including COBRA or other
continuation coverage or conversion coverage, maintained for any
preexisting condition waiting period under a pool policy or during
any preexisting condition waiting period or other waiting period of
the other coverage;
(B) employer group coverage conditioned by a
limitation of the kind described by Section 1506.152(a)(3)(A) or
(C); or
(C) individual coverage conditioned by a
limitation described by Section 1506.152(a)(3)(C) or (D);
(3) within 12 months before the date the individual
applies to the pool, the individual terminated coverage in the
pool, unless the individual:
(A) demonstrates a good faith reason for the
termination; or
(B) is a federally defined eligible individual;
(4) the individual is confined in a county jail or
imprisoned in a state or federal prison;
(5) any of the individual's premiums are paid for or
reimbursed under a government-sponsored program or by a government
agency or health care provider;
(6) the individual's prior coverage with the pool was
terminated:
(A) during the 12-month period preceding the date
of application for nonpayment of premiums; or
(B) for fraud; or
(7) the individual is eligible for health benefit plan
coverage provided in connection with a policy, plan, or program
paid for or sponsored by an employer, even though the employer
coverage is declined. This subdivision does not apply to an
individual who is a part-time employee or a part-time employee's
dependent eligible to participate in an employer plan that provides
health benefit coverage:
(A) that is more limited or restricted than
coverage with the pool; and
(B) for which there is no employer contribution
to the premium, either directly or indirectly.
(b) An individual eligible for benefits from the
continuation of coverage under Title X, Consolidated Omnibus Budget
Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)[, as
amended] (COBRA), or a comparable federal or state employee
coverage continuation program, who did not elect continuation of
coverage during the election period, or whose elected continuation
of coverage lapsed or was cancelled without reinstatement, is
eligible for pool coverage. Eligibility under this subsection is
subject to a minimum 180-day exclusion of coverage under Section
1506.155(a-1).
SECTION 6. Section 1506.155, Insurance Code, is amended by
amending Subsection (a-1) and adding Subsection (c-1) to read as
follows:
(a-1) Except as provided by Section 1506.056, pool coverage
for an individual eligible pursuant to Section 1506.153(b) excludes
charges or expenses incurred before the first anniversary of [the
expiration of 180 days from] the effective date of coverage with
regard to any condition for which:
(1) the existence of symptoms would cause an
ordinarily prudent person to seek diagnosis, care, or treatment
within the six-month period preceding the effective date of
coverage; or
(2) medical advice, care, or treatment was recommended
or received during the six-month period preceding the effective
date of coverage.
(c-1) If an individual eligible under Section 1506.153(b)
was covered by creditable coverage at any time during the 12-month
period immediately preceding the effective date of the individual's
coverage under the pool, the pool shall subtract from the exclusion
period required under Subsection (a-1) up to 180 days of:
(1) the period during which the individual was
covered under the creditable coverage; and
(2) any waiting period that applied before the
creditable coverage became effective.
SECTION 7. Subsection (b), Section 1506.2523, Insurance
Code, is amended to read as follows:
(b) For purposes of this section, gross health benefit plan
premiums do not include premiums collected for:
(1) coverage under a Medicare supplement benefit plan
subject to Chapter 1652;
(2) coverage under a small employer health benefit
plan subject to Subchapters A-H, Chapter 1501; or
(3) coverage or insurance listed in Section
1506.002(b), (c), or (d).
SECTION 8. This Act applies only to an application for
initial or renewal coverage through the Texas Health Insurance Risk
Pool under Chapter 1506, Insurance Code, as amended by this Act,
that is filed with the pool on or after January 1, 2010. An
application filed before that date is governed by the law in effect
on the date on which the application was filed, and the former law
is continued in effect for that purpose.
SECTION 9. This Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1403 passed the Senate on
April 9, 2009, by the following vote: Yeas 31, Nays 0.
______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1403 passed the House on
May 26, 2009, by the following vote: Yeas 144, Nays 0, one
present not voting.
______________________________
Chief Clerk of the House
Approved:
______________________________
Date
______________________________
Governor