| 1 | 1 | | 84R10189 PMO-D |
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| 2 | 2 | | By: Faircloth H.B. No. 3381 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to submission and payment of claims under long-term care |
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| 8 | 8 | | benefit plans; imposing a penalty. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subchapter B, Chapter 1651, Insurance Code, is |
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| 11 | 11 | | amended by adding Sections 1651.057, 1651.058, and 1651.059 to read |
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| 12 | 12 | | as follows: |
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| 13 | 13 | | Sec. 1651.057. SUBMISSION OF CLAIM. An individual covered |
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| 14 | 14 | | by a long-term care benefit plan may submit a claim under the plan |
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| 15 | 15 | | to the plan issuer by: |
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| 16 | 16 | | (1) mailing the claim by United States mail, first |
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| 17 | 17 | | class, or by overnight delivery service; |
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| 18 | 18 | | (2) submitting the claim electronically; |
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| 19 | 19 | | (3) faxing the claim; or |
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| 20 | 20 | | (4) hand delivering the claim. |
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| 21 | 21 | | Sec. 1651.058. RECEIPT OF CLAIM. (a) If a claim under a |
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| 22 | 22 | | long-term care benefit plan is mailed, the claim is presumed to have |
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| 23 | 23 | | been received by the plan issuer on the fifth day after the date the |
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| 24 | 24 | | claim is mailed or, if the claim is mailed using overnight service |
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| 25 | 25 | | or a return receipt is requested, on the date the delivery receipt |
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| 26 | 26 | | is signed. |
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| 27 | 27 | | (b) If the claim is submitted electronically, the claim is |
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| 28 | 28 | | presumed to have been received on the date of transmission. |
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| 29 | 29 | | (c) If the claim is faxed, the claim is presumed to have been |
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| 30 | 30 | | received on the date of the transmission acknowledgment. |
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| 31 | 31 | | (d) If the claim is hand delivered, the claim is presumed to |
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| 32 | 32 | | have been received on the date the delivery receipt is signed. |
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| 33 | 33 | | Sec. 1651.059. PAYMENT OF CLAIM; PENALTY. (a) A long-term |
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| 34 | 34 | | care benefit plan issuer shall pay a claim for which the covered |
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| 35 | 35 | | individual is entitled to payment under the terms of the plan not |
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| 36 | 36 | | later than the 30th day after the date the plan issuer receives the |
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| 37 | 37 | | claim. |
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| 38 | 38 | | (b) A long-term care benefit plan issuer that violates |
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| 39 | 39 | | Subsection (a) shall pay to the covered individual the amount the |
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| 40 | 40 | | plan issuer owes on the claim plus a penalty in the amount of $500. |
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| 41 | 41 | | SECTION 2. Sections 1651.057, 1651.058, and 1651.059, |
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| 42 | 42 | | Insurance Code, as added by this Act, apply only to a claim |
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| 43 | 43 | | submitted on or after the effective date of this Act. A claim |
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| 44 | 44 | | submitted before the effective date of this Act is governed by the |
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| 45 | 45 | | law as it existed immediately before that date, and that law is |
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| 46 | 46 | | continued in effect for that purpose. |
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| 47 | 47 | | SECTION 3. This Act takes effect September 1, 2015. |
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