85R10998 SMT-D
By: Muñoz, Jr. H.B. No. 2630
A BILL TO BE ENTITLED
AN ACT
relating to the reporting of certain claims information by certain
insurers and health benefit plan issuers to the Texas Department of
Insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 38, Insurance Code, is amended by adding
Subchapter K to read as follows:
SUBCHAPTER K. CLAIM REPORTING BY CERTAIN INSURERS AND HEALTH
BENEFIT PLAN ISSUERS
Sec. 38.501. CLAIM REPORTING REQUIREMENTS. (a) In this
section:
(1) "Health benefit plan issuer" means the issuer of a
health benefit plan that provides benefits for medical or surgical
expenses incurred as a result of a health condition, accident, or
sickness, including an individual, group, blanket, or franchise
policy or insurance agreement, a group hospital service contract,
or an evidence of coverage or similar coverage document. The term
includes:
(A) a plan issued by:
(i) an insurer;
(ii) a health maintenance organization
operating under Chapter 843; or
(iii) a group hospital service corporation
operating under Chapter 842;
(B) notwithstanding any provision in Chapter
1551, 1575, 1579, or 1601:
(i) a basic coverage plan under Chapter
1551;
(ii) a basic plan under Chapter 1575;
(iii) a primary care coverage plan under
Chapter 1579; or
(iv) basic coverage under Chapter 1601;
(C) group health coverage made available by a
school district in accordance with Section 22.004, Education Code;
(D) coverage provided under the state Medicaid
program, including the Medicaid managed care program operated under
Chapter 533, Government Code; and
(E) coverage provided under the child health plan
program under Chapter 62, Health and Safety Code.
(2) "Insurer" means an insurance company, reciprocal
or interinsurance exchange, mutual insurance company, capital
stock company, county mutual insurance company, Lloyd's plan, or
other legal entity authorized to engage in the business of
insurance in this state.
(b) An insurer engaged in the business of personal
automobile or residential property insurance or a health benefit
plan issuer shall submit a quarterly report to the department
containing the following information organized by zip code:
(1) the number of claims filed with the insurer under
personal automobile or residential property insurance policies, as
applicable, or the number of health benefit claims filed with the
health benefit plan issuer;
(2) the number of claims denied; and
(3) for each claim denied, the reason for the denial.
(c) The commissioner by rule shall adopt the form of the
report required under Subsection (b).
SECTION 2. Not later than December 31, 2017, the
commissioner of insurance shall adopt rules as necessary to
implement Subchapter K, Chapter 38, Insurance Code, as added by
this Act. The rules must require that an insurer or health benefit
plan issuer subject to that subchapter make the initial submission
of the report under that subchapter not later than the 60th day
after the effective date of the rules.
SECTION 3. This Act takes effect September 1, 2017.