Texas 2011 - 82nd Regular

Texas House Bill HB1253 Compare Versions

The same version is selected twice. Please select two different versions to compare.

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	82R20189 RWG-F
2	2	By: Smithee, Hardcastle, Eiland, Nash H.B. No. 1253
3	3	Substitute the following for H.B. No. 1253:
4	4	By: Smithee C.S.H.B. No. 1253
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to certain modifications of a health benefit plan.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is
12	12	amended by adding Section 1369.0541 to read as follows:
13	13	Sec. 1369.0541. MODIFICATION OF DRUG COVERAGE UNDER PLAN.
14	14	(a) In addition to applying to a group health benefit plan to which
15	15	this subchapter applies, this section applies to an individual
16	16	health benefit plan, as defined by Section 544.501.
17	17	(b) Notwithstanding Section 1369.053, this section applies
18	18	to a small employer health benefit plan written under Chapter 1501.
19	19	(c) A group or individual health benefit plan issuer may
20	20	modify drug coverage provided under a health benefit plan if:
21	21	(1) the modification occurs at the time of coverage
22	22	renewal;
23	23	(2) the modification is effective uniformly among all
24	24	group health benefit plan sponsors covered by identical or
25	25	substantially identical health benefit plans or all individuals
26	26	covered by identical or substantially identical individual health
27	27	benefit plans, as applicable; and
28	28	(3) not later than the 60th day before the date the
29	29	modification is effective, the issuer provides written notice of
30	30	the modification to the commissioner, each affected group health
31	31	benefit plan sponsor, each affected enrollee in an affected group
32	32	health benefit plan, and each affected individual health benefit
33	33	plan holder.
34	34	(d) Modifications affecting drug coverage that require
35	35	notice under Subsection (c) include:
36	36	(1) removing a drug from a formulary;
37	37	(2) adding a requirement that an enrollee receive
38	38	prior authorization for a drug;
39	39	(3) imposing or altering a quantity limit for a drug;
40	40	(4) imposing a step-therapy restriction for a drug;
41	41	and
42	42	(5) moving a drug to a higher cost-sharing tier unless
43	43	a generic drug alternative to the drug is available.
44	44	(e) A group or individual health benefit plan issuer may
45	45	elect to offer an enrollee in the plan the option of receiving
46	46	notifications required by this section by e-mail.
47	47	SECTION 2. Section 1501.108(d), Insurance Code, is amended
48	48	to read as follows:
49	49	(d) Notwithstanding Subsection (a), a small or large
50	50	employer health benefit plan issuer may modify a small or large
51	51	employer health benefit plan in accordance with Section 1369.0541
52	52	or if:
53	53	(1) the modification occurs at the time of coverage
54	54	renewal;
55	55	(2) the modification is effective uniformly among all
56	56	small or large employers covered by that health benefit plan; and
57	57	(3) the issuer notifies the commissioner and each
58	58	affected covered small or large employer of the modification not
59	59	later than the 60th day before the date the modification is
60	60	effective.
61	61	SECTION 3. This Act takes effect September 1, 2011.