2009S0658-1 03/10/09
By: Carona S.B. No. 1978
A BILL TO BE ENTITLED
AN ACT
relating to requirements regarding employer liability for certain
group health benefit plan premiums.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 843.210, Insurance Code, is amended to
read as follows:
Sec. 843.210. TERMS OF ENROLLEE ELIGIBILITY. (a) A
contract between a health maintenance organization and a group
contract holder must provide that:
(1) in addition to any other premiums for which the
group contract holder is liable, the group contract holder is
liable for an enrollee's premiums from the time the enrollee is no
longer part of the group eligible for coverage under the contract
until the end of the month in which the contract holder notifies the
health maintenance organization that the enrollee is no longer part
of the group eligible for coverage by the contract; and
(2) the enrollee remains covered by the contract until
the end of that period.
(b) A health maintenance organization shall refund premiums
paid by a group contract holder on behalf of an enrollee, from the
end of the month during which the enrollee is no longer part of the
group eligible for coverage, provided that the enrollee did not
incur any claims under the contract after no longer being part of
the group eligible for coverage.
(c) The commissioner shall adopt rules as necessary to
implement this section.
SECTION 2. Section 1301.0061, Insurance Code, is amended to
read as follows:
Sec. 1301.0061. TERMS OF ENROLLEE ELIGIBILITY. (a) A
contract between an insurer and a group policyholder under a
preferred provider benefit plan must provide that:
(1) in addition to any other premiums for which the
group policyholder is liable, the group policyholder is liable for
an individual insured's premiums from the time the individual is no
longer part of the group eligible for coverage under the policy
until the end of the month in which the policyholder notifies the
insurer that the individual is no longer part of the group eligible
for coverage under the policy; and
(2) the individual remains covered under the policy
until the end of that period.
(b) An insurer shall refund premiums paid by a group
policyholder on behalf of an individual, from the end of the month
during which the individual is no longer part of the group eligible
for coverage, provided that the individual did not incur any claims
under the policy after no longer being part of the group eligible
for coverage.
(c) The commissioner shall adopt rules as necessary to
implement this section.
SECTION 3. The change in law made by this Act applies only
to a contract between an insurer or health maintenance organization
and a group policy or contract holder that is entered into or
renewed on or after January 1, 2010. A contract entered into or
renewed before January 1, 2010, is governed by the law in effect
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2009.