Texas 2009 - 81st Regular

Texas Senate Bill SB1771 Compare Versions

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1	1	S.B. No. 1771
2	2
3	3
4	4	AN ACT
5	5	relating to the availability and continuation of certain health
6	6	benefit plan coverage.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Subtitle A, Title 8, Insurance Code, is amended
9	9	by adding Chapter 1202A to read as follows:
10	10	CHAPTER 1202A. TEMPORARY EXTENSION OF ELECTION PERIOD FOR
11	11	CONTINUATION OF CERTAIN COVERAGE
12	12	Sec. 1202A.001. EXTENSION OF ELECTION PERIOD. (a) For the
13	13	purposes of this section, an "extended election eligible
14	14	individual" means an employee, member, dependent, or enrollee:
15	15	(1) who became eligible for continuation coverage due
16	16	to involuntary termination, other than involuntary termination for
17	17	cause, under Subchapter F, Chapter 1251, or Subchapter G, Chapter
18	18	1271, at any time during the period that begins on September 1,
19	19	2008, and ends on February 16, 2009;
20	20	(2) who did not elect such coverage or whose elected
21	21	continuation coverage lapsed or was canceled without reinstatement
22	22	for a reason other than exhaustion of the maximum period of
23	23	continuation coverage allowable under law; and
24	24	(3) whose involuntary termination on which the
25	25	eligibility is based occurred during that same period.
26	26	(b) Notwithstanding Section 1251.253 or 1271.301, an
27	27	extended election eligible individual may elect continuation
28	28	coverage under this section beginning on the effective date of S.B.
29	29	No. 1771, Acts of the 81st Legislature, Regular Session, 2009, and
30	30	ending on the 60th day after the date on which the notification
31	31	required by Subsection (e) is provided to the individual.
32	32	(c) The period of continuation coverage for an extended
33	33	election eligible individual who elects continuation coverage
34	34	begins with the first period of coverage beginning on or after the
35	35	effective date of S.B. No. 1771, Acts of the 81st Legislature,
36	36	Regular Session, 2009, and does not extend beyond the date the
37	37	period of continuation coverage would have ended if the coverage
38	38	had been elected during the election period required under the law
39	39	as it existed before the effective date of S.B. No. 1771, Acts of
40	40	the 81st Legislature, Regular Session, 2009.
41	41	(d) With respect to an individual who elects continuation
42	42	coverage under Subsection (b), the period beginning on the date the
43	43	individual first became eligible for continuation coverage and
44	44	ending on the first day of the 60-day election period described by
45	45	Subsection (b) shall be disregarded for purposes of determining a
46	46	63-day period referred to in 29 U.S.C. Section 1181(c)(2), 42
47	47	U.S.C. Section 300gg(c)(2), 26 U.S.C. Section 9801(c)(2), and
48	48	Sections 846.202(d), 1501.102, and 1506.001(8).
49	49	(e) Not later than the 60th day after the effective date of
50	50	S.B. No. 1771, Acts of the 81st Legislature, Regular Session, 2009,
51	51	an employer or group policy or contract holder shall provide notice
52	52	to any former employee, member, dependent, or enrollee who is an
53	53	extended election eligible individual that includes:
54	54	(1) a description of the extended election period
55	55	available to the individual under this section;
56	56	(2) a description, displayed in a prominent manner, of
57	57	the individual's right to a reduced premium and any conditions on
58	58	entitlement to the reduced premium under the American Recovery and
59	59	Reinvestment Act of 2009 (Pub. L. No. 111-5);
60	60	(3) a form that allows the individual to request
61	61	treatment as an assistance eligible individual, as defined by the
62	62	American Recovery and Reinvestment Act of 2009 (Pub. L. No. 111-5),
63	63	to whom the premium subsidy would apply;
64	64	(4) the amount continuation coverage will cost and the
65	65	period of coverage available;
66	66	(5) an election form that includes the return address
67	67	and the due date for making the election; and
68	68	(6) notice that if the individual is entitled to the
69	69	reduced premium and later becomes eligible for other group health
70	70	plan coverage or Medicare, the individual must notify the employer
71	71	in writing or the individual may be subject to a tax penalty.
72	72	Sec. 1202A.002. EXPIRATION OF CHAPTER. This chapter
73	73	expires September 1, 2013.
74	74	SECTION 2. Section 1251.253, Insurance Code, is amended to
75	75	read as follows:
76	76	Sec. 1251.253. REQUEST FOR CONTINUATION OF GROUP COVERAGE.
77	77	An employee, member, or dependent must provide to the employer or
78	78	group policyholder a written request for [in writing the]
79	79	continuation of group coverage not later than the 60th [31st] day
80	80	after the later of:
81	81	(1) the date the group coverage would otherwise
82	82	terminate; or
83	83	(2) the date the individual is given, in a format
84	84	prescribed by the commissioner, notice by either the employer or
85	85	the group policyholder of the right to continuation of group
86	86	coverage.
87	87	SECTION 3. Section 1251.254, Insurance Code, is amended to
88	88	read as follows:
89	89	Sec. 1251.254. PAYMENT OF CONTRIBUTIONS. Except as
90	90	provided by this section, an [(a) An] employee, member, or
91	91	dependent who elects to continue group coverage under this
92	92	subchapter must pay to the employer or group policyholder[,] each
93	93	month [in advance,] the amount of contribution required by the
94	94	employer or policyholder, plus two percent of the group rate for the
95	95	coverage being continued under the group policy [on the due date of
96	96	each payment]. A payment under this section must be made not later
97	97	than the 45th day after the date of the initial election for
98	98	coverage and on the due date of each payment thereafter. Following
99	99	the first payment made after the initial election for coverage, the
100	100	payment of any other premium shall be considered timely if made on
101	101	or before the 30th day after the date on which the payment is due.
102	102	[(b) The employee's, member's, or dependent's written
103	103	election for continuation of group coverage, together with the
104	104	first contribution required to establish advance monthly
105	105	contributions, must be given to the employer or policyholder not
106	106	later than the later of:
107	107	[(1) the 31st day after the date coverage would
108	108	otherwise terminate; or
109	109	[(2) the date the individual is given notice by either
110	110	the employer or the group policyholder of the right to continuation
111	111	of group coverage.]
112	112	SECTION 4. Section 1251.255, Insurance Code, is amended to
113	113	read as follows:
114	114	Sec. 1251.255. TERMINATION OF CONTINUED COVERAGE.
115	115	(a) Group coverage continued under this subchapter may not
116	116	terminate until the earliest of:
117	117	(1) the date the maximum continuation period provided
118	118	by law would end, which is:
119	119	(A) for any employee, member, or dependent not
120	120	eligible for continuation coverage under Title X, Consolidated
121	121	Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161
122	122	et seq.) (COBRA), nine [six] months after the date the employee,
123	123	member, or dependent elects to continue the group coverage; or
124	124	(B) for any employee, member, or dependent
125	125	eligible for continuation coverage under COBRA, six additional
126	126	months following any period of continuation coverage provided under
127	127	COBRA;
128	128	(2) the date failure to make timely payments would
129	129	terminate the group coverage;
130	130	(3) the date the group coverage terminates in its
131	131	entirety;
132	132	(4) the date the insured is or could be covered under
133	133	Medicare;
134	134	(5) the date the insured is covered for similar
135	135	benefits by another plan or program, including:
136	136	(A) a hospital, surgical, medical, or major
137	137	medical expense insurance policy;
138	138	(B) a hospital or medical service subscriber
139	139	contract; or
140	140	(C) a medical practice or other prepayment plan;
141	141	(6) the date the insured is eligible for similar
142	142	benefits, whether or not covered for those benefits, under any
143	143	arrangement of coverage for individuals in a group, whether on an
144	144	insured or uninsured basis; or
145	145	(7) the date similar benefits are provided or
146	146	available to the insured under any state or federal law other than
147	147	continuation coverage under Title X, Consolidated Omnibus Budget
148	148	Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)
149	149	(COBRA).
150	150	(b) Not later than the 30th day before the end of the
151	151	continuation period described by Subsection (a)(1) that is
152	152	applicable to the individual [six months after the date the
153	153	employee, member, or dependent elects to continue group coverage
154	154	under the policy], the insurer shall:
155	155	(1) notify the individual that the individual may be
156	156	eligible for coverage under the Texas Health Insurance Risk Pool as
157	157	provided by Chapter 1506; and
158	158	(2) provide to the individual the address for applying
159	159	to that pool.
160	160	SECTION 5. Section 1271.302, Insurance Code, is amended to
161	161	read as follows:
162	162	Sec. 1271.302. REQUEST FOR CONTINUED COVERAGE; DEADLINE.
163	163	An enrollee must provide to the employer or group contract holder
164	164	[make] a written notice of election to continue group coverage
165	165	under this subchapter [and pay the first contribution required to
166	166	establish contributions on an advance monthly basis to the employer
167	167	or group contract holder] not later than the 60th [31st] day after
168	168	the later of:
169	169	(1) the date the group coverage would otherwise
170	170	terminate; or
171	171	(2) the date the enrollee is given notice of the right
172	172	of continuation by the employer or group contract holder.
173	173	SECTION 6. Subsection (b), Section 1271.303, Insurance
174	174	Code, is amended to read as follows:
175	175	(b) The enrollee must make the payment not later than the
176	176	45th day after the initial election for coverage and on the due date
177	177	of each payment thereafter. Following the first payment made after
178	178	the initial election for coverage, the payment of any other premium
179	179	shall be considered timely if made by the 30th day after the date on
180	180	which payment is due [in advance on a monthly basis on the due date
181	181	of each payment].
182	182	SECTION 7. Section 1271.304, Insurance Code, is amended to
183	183	read as follows:
184	184	Sec. 1271.304. TERMINATION OF CONTINUED COVERAGE. Group
185	185	continued coverage under this subchapter may not terminate until
186	186	the earliest of:
187	187	(1) the date the maximum continuation period provided
188	188	by law would end, which is:
189	189	(A) for any enrollee not eligible for
190	190	continuation coverage under Title X, Consolidated Omnibus Budget
191	191	Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)
192	192	(COBRA), the end of the nine-month [six-month] period after the
193	193	date the election to continue coverage is made; or
194	194	(B) for any enrollee eligible for continuation
195	195	coverage under COBRA, six additional months following any period of
196	196	continuation provided under that statute;
197	197	(2) the date on which failure to make timely payments
198	198	terminates coverage;
199	199	(3) the date on which the enrollee is covered for
200	200	similar services and benefits by any other plan or program,
201	201	including a hospital, surgical, medical, or major medical expense
202	202	insurance policy, hospital or medical service subscriber contract,
203	203	or medical practice or other prepayment plan; or
204	204	(4) the date on which the group coverage terminates in
205	205	its entirety.
206	206	SECTION 8. Subsection (a), Section 1271.305, Insurance
207	207	Code, is amended to read as follows:
208	208	(a) At least 30 days before the end of the continuation
209	209	[six-month] period described by Section 1271.304(1) that is
210	210	applicable to the enrollee [after the date an enrollee elects to
211	211	continue group coverage], the health maintenance organization
212	212	shall notify the enrollee that the enrollee may be eligible for
213	213	coverage under the Texas Health Insurance Risk Pool as provided by
214	214	Chapter 1506.
215	215	SECTION 9. Section 1506.153, Insurance Code, is amended by
216	216	adding Subsections (c) and (d) to read as follows:
217	217	(c) An individual eligible for benefits from the
218	218	continuation of coverage under Subchapter F or G, Chapter 1251, or
219	219	Subchapter G, Chapter 1271, who did not elect continuation coverage
220	220	during the election period, or whose elected continuation coverage
221	221	lapsed or was canceled without reinstatement, is eligible for pool
222	222	coverage. Eligibility under this subsection is subject to a
223	223	180-day exclusion of coverage under Section 1506.155(a-1).
224	224	(d) The 180-day exclusion of coverage provided under
225	225	Subsection (c) does not apply to an individual eligible for
226	226	benefits from the continuation of coverage under Subchapter F or G,
227	227	Chapter 1251, or Subchapter G, Chapter 1271, who did not elect
228	228	continuation coverage during the election period, or whose elected
229	229	continuation coverage lapsed or was canceled without
230	230	reinstatement, following a period of continuation coverage under
231	231	Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29
232	232	U.S.C. Section 1161 et seq.) (COBRA).
233	233	SECTION 10. Subsection (a-1), Section 1506.155, Insurance
234	234	Code, is amended to read as follows:
235	235	(a-1) Except as provided by Section 1506.056, pool coverage
236	236	for an individual eligible pursuant to Section 1506.153(b) or (c)
237	237	excludes charges or expenses incurred before the expiration of 180
238	238	days from the effective date of coverage with regard to any
239	239	condition for which:
240	240	(1) the existence of symptoms would cause an
241	241	ordinarily prudent person to seek diagnosis, care, or treatment
242	242	within the six-month period preceding the effective date of
243	243	coverage; or
244	244	(2) medical advice, care, or treatment was recommended
245	245	or received during the six-month period preceding the effective
246	246	date of coverage.
247	247	SECTION 11. (a) Sections 1251.253 and 1271.302, Insurance
248	248	Code, as amended by this Act, apply only to:
249	249	(1) a request for continuation of group coverage that
250	250	an employee, member, dependent, or enrollee becomes eligible to
251	251	make on or after the effective date of this Act; or
252	252	(2) a request for continuation of group coverage that
253	253	an employee, member, dependent, or enrollee became eligible to make
254	254	before the effective date of this Act, provided that the election
255	255	period available to the employee, member, dependent, or enrollee
256	256	under Section 1251.253 or 1271.302, Insurance Code, as those
257	257	sections existed before amendment by this Act, has not expired as of
258	258	the effective date of this Act.
259	259	(b) A request for continuation of group coverage that an
260	260	employee, member, dependent, or enrollee became eligible to make
261	261	before the effective date of this Act and that, on the effective
262	262	date of this Act, the employee, member, dependent, or enrollee is no
263	263	longer eligible to make, is governed by the law as it existed before
264	264	the effective date of this Act, and that law is continued in effect
265	265	for that purpose. This subsection does not apply to an employee,
266	266	member, dependent, or enrollee who is an extended election eligible
267	267	individual to whom Chapter 1202A, Insurance Code, as added by this
268	268	Act, applies.
269	269	SECTION 12. Sections 1251.254 and 1271.303, Insurance Code,
270	270	as amended by this Act, apply only to a payment for continuation
271	271	coverage required to be made on or after the effective date of this
272	272	Act. A payment for continuation coverage required to be made before
273	273	the effective date of this Act is governed by the law as it existed
274	274	before that date, and that law is continued in effect for that
275	275	purpose.
276	276	SECTION 13. Sections 1251.255 and 1271.304, Insurance Code,
277	277	as amended by this Act, apply to coverage for which an election to
278	278	continue was made on or after the effective date of this Act.
279	279	SECTION 14. This Act takes effect immediately if it
280	280	receives a vote of two-thirds of all the members elected to each
281	281	house, as provided by Section 39, Article III, Texas Constitution.
282	282	If this Act does not receive the vote necessary for immediate
283	283	effect, this Act takes effect September 1, 2009.
284	284	______________________________ ______________________________
285	285	President of the Senate Speaker of the House
286	286	I hereby certify that S.B. No. 1771 passed the Senate on
287	287	April 14, 2009, by the following vote: Yeas 30, Nays 0.
288	288	______________________________
289	289	Secretary of the Senate
290	290	I hereby certify that S.B. No. 1771 passed the House on
291	291	May 26, 2009, by the following vote: Yeas 144, Nays 0, one
292	292	present not voting.
293	293	______________________________
294	294	Chief Clerk of the House
295	295	Approved:
296	296	______________________________
297	297	Date
298	298	______________________________
299	299	Governor