81R8791 AJA-D
By: Duncan S.B. No. 1771
A BILL TO BE ENTITLED
AN ACT
relating to the availability and continuation of certain health
benefit plan coverage.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1251.253, Insurance Code, is amended to
read as follows:
Sec. 1251.253. REQUEST FOR CONTINUATION OF GROUP COVERAGE.
An employee, member, or dependent must request in writing the
continuation of group coverage not later than the 60th [31st] day
after the later of:
(1) the date the group coverage would otherwise
terminate; or
(2) the date the individual is given, in a format
prescribed by the commissioner, notice by either the employer or
the group policyholder of the right to continuation of group
coverage.
SECTION 2. Section 1251.254, Insurance Code, is amended to
read as follows:
Sec. 1251.254. PAYMENT OF CONTRIBUTIONS. (a) Except as
provided by this section, an [An] employee, member, or dependent
who elects to continue group coverage under this subchapter must
pay to the employer or group policyholder[,] each month [in
advance,] the amount of contribution required by the employer or
policyholder, plus two percent of the group rate for the coverage
being continued under the group policy on the due date of each
payment. A payment under this subsection must be made not later
than the 30th day after the date on which the payment is due.
(b) The employee's, member's, or dependent's written
election for continuation of group coverage, together with the
first contribution required [to establish advance monthly
contributions], must be given to the employer or policyholder not
later than the later of:
(1) the 31st day after the date coverage would
otherwise terminate; or
(2) the date the individual is given notice by either
the employer or the group policyholder of the right to continuation
of group coverage.
SECTION 3. Section 1251.255, Insurance Code, is amended to
read as follows:
Sec. 1251.255. TERMINATION OF CONTINUED COVERAGE. (a)
Group coverage continued under this subchapter may not terminate
until the earliest of:
(1) 18 [six] months after the date the employee,
member, or dependent elects to continue the group coverage;
(2) the date failure to make timely payments would
terminate the group coverage;
(3) the date the group coverage terminates in its
entirety;
(4) the date the insured is or could be covered under
Medicare;
(5) the date the insured is covered for similar
benefits by another plan or program, including:
(A) a hospital, surgical, medical, or major
medical expense insurance policy;
(B) a hospital or medical service subscriber
contract; or
(C) a medical practice or other prepayment plan;
(6) the date the insured is eligible for similar
benefits, whether or not covered for those benefits, under any
arrangement of coverage for individuals in a group, whether on an
insured or uninsured basis; or
(7) the date similar benefits are provided or
available to the insured under any state or federal law.
(b) Not later than the 30th day before the end of the 18
[six] months after the date the employee, member, or dependent
elects to continue group coverage under the policy, the insurer
shall:
(1) notify the individual that the individual may be
eligible for coverage under the Texas Health Insurance Risk Pool as
provided by Chapter 1506; and
(2) provide to the individual the address for applying
to that pool.
SECTION 4. Section 1506.153, Insurance Code, is amended by
adding Subsection (c) to read as follows:
(c) An individual eligible for benefits from the
continuation of coverage under Subchapter F or G, Chapter 1251, who
did not elect continuation of coverage during the election period,
or whose elected continuation of coverage lapsed or was canceled
without reinstatement, is eligible for pool coverage. Eligibility
under this subsection is subject to a 180-day exclusion of coverage
under Section 1506.155(a-1).
SECTION 5. Section 1506.155(a-1), Insurance Code, is
amended 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) or (c)
excludes charges or expenses incurred before 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.
SECTION 6. (a) Section 1251.253, Insurance Code, as
amended by this Act, applies only to:
(1) a request for continuation of group coverage that
an employee, member, or dependent becomes eligible to make on or
after the effective date of this Act; or
(2) a request for continuation of group coverage that:
(A) an employee, member, or dependent became
eligible to make before the effective date of this Act; and
(B) on the effective date of this Act, the
employee, member, or dependent would have remained eligible to make
under Section 1251.253, Insurance Code, as it existed before
amendment by this Act.
(b) A request for continuation of group coverage that an
employee, member, or dependent became eligible to make before the
effective date of this Act and that, on the effective date of this
Act, the employee, member, or dependent is no longer eligible to
make, is governed by the law as it existed before the effective date
of this Act, and that law is continued in effect for that purpose.
SECTION 7. Section 1251.254, Insurance Code, as amended by
this Act, applies only to a payment for continuation coverage
required to be made on or after the effective date of this Act. A
payment for continuation coverage required to be made before the
effective date of this Act is governed by the law as it existed
before that date, and that law is continued in effect for that
purpose.
SECTION 8. Section 1251.255, Insurance Code, as amended by
this Act, applies to coverage for which an election to continue was
made on or after September 1, 2008, that is in effect on the
effective date of this Act.
SECTION 9. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2009.