84R10189 PMO-D
By: Faircloth H.B. No. 3381
A BILL TO BE ENTITLED
AN ACT
relating to submission and payment of claims under long-term care
benefit plans; imposing a penalty.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 1651, Insurance Code, is
amended by adding Sections 1651.057, 1651.058, and 1651.059 to read
as follows:
Sec. 1651.057. SUBMISSION OF CLAIM. An individual covered
by a long-term care benefit plan may submit a claim under the plan
to the plan issuer by:
(1) mailing the claim by United States mail, first
class, or by overnight delivery service;
(2) submitting the claim electronically;
(3) faxing the claim; or
(4) hand delivering the claim.
Sec. 1651.058. RECEIPT OF CLAIM. (a) If a claim under a
long-term care benefit plan is mailed, the claim is presumed to have
been received by the plan issuer on the fifth day after the date the
claim is mailed or, if the claim is mailed using overnight service
or a return receipt is requested, on the date the delivery receipt
is signed.
(b) If the claim is submitted electronically, the claim is
presumed to have been received on the date of transmission.
(c) If the claim is faxed, the claim is presumed to have been
received on the date of the transmission acknowledgment.
(d) If the claim is hand delivered, the claim is presumed to
have been received on the date the delivery receipt is signed.
Sec. 1651.059. PAYMENT OF CLAIM; PENALTY. (a) A long-term
care benefit plan issuer shall pay a claim for which the covered
individual is entitled to payment under the terms of the plan not
later than the 30th day after the date the plan issuer receives the
claim.
(b) A long-term care benefit plan issuer that violates
Subsection (a) shall pay to the covered individual the amount the
plan issuer owes on the claim plus a penalty in the amount of $500.
SECTION 2. Sections 1651.057, 1651.058, and 1651.059,
Insurance Code, as added by this Act, apply only to a claim
submitted on or after the effective date of this Act. A claim
submitted before the effective date of this Act is governed by the
law as it existed immediately before that date, and that law is
continued in effect for that purpose.
SECTION 3. This Act takes effect September 1, 2015.