Texas 2017 - 85th Regular

Texas House Bill HB2630 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	85R10998 SMT-D
2	2	By: Muñoz, Jr. H.B. No. 2630
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the reporting of certain claims information by certain
8	8	insurers and health benefit plan issuers to the Texas Department of
9	9	Insurance.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Chapter 38, Insurance Code, is amended by adding
12	12	Subchapter K to read as follows:
13	13	SUBCHAPTER K. CLAIM REPORTING BY CERTAIN INSURERS AND HEALTH
14	14	BENEFIT PLAN ISSUERS
15	15	Sec. 38.501. CLAIM REPORTING REQUIREMENTS. (a) In this
16	16	section:
17	17	(1) "Health benefit plan issuer" means the issuer of a
18	18	health benefit plan that provides benefits for medical or surgical
19	19	expenses incurred as a result of a health condition, accident, or
20	20	sickness, including an individual, group, blanket, or franchise
21	21	policy or insurance agreement, a group hospital service contract,
22	22	or an evidence of coverage or similar coverage document. The term
23	23	includes:
24	24	(A) a plan issued by:
25	25	(i) an insurer;
26	26	(ii) a health maintenance organization
27	27	operating under Chapter 843; or
28	28	(iii) a group hospital service corporation
29	29	operating under Chapter 842;
30	30	(B) notwithstanding any provision in Chapter
31	31	1551, 1575, 1579, or 1601:
32	32	(i) a basic coverage plan under Chapter
33	33	1551;
34	34	(ii) a basic plan under Chapter 1575;
35	35	(iii) a primary care coverage plan under
36	36	Chapter 1579; or
37	37	(iv) basic coverage under Chapter 1601;
38	38	(C) group health coverage made available by a
39	39	school district in accordance with Section 22.004, Education Code;
40	40	(D) coverage provided under the state Medicaid
41	41	program, including the Medicaid managed care program operated under
42	42	Chapter 533, Government Code; and
43	43	(E) coverage provided under the child health plan
44	44	program under Chapter 62, Health and Safety Code.
45	45	(2) "Insurer" means an insurance company, reciprocal
46	46	or interinsurance exchange, mutual insurance company, capital
47	47	stock company, county mutual insurance company, Lloyd's plan, or
48	48	other legal entity authorized to engage in the business of
49	49	insurance in this state.
50	50	(b) An insurer engaged in the business of personal
51	51	automobile or residential property insurance or a health benefit
52	52	plan issuer shall submit a quarterly report to the department
53	53	containing the following information organized by zip code:
54	54	(1) the number of claims filed with the insurer under
55	55	personal automobile or residential property insurance policies, as
56	56	applicable, or the number of health benefit claims filed with the
57	57	health benefit plan issuer;
58	58	(2) the number of claims denied; and
59	59	(3) for each claim denied, the reason for the denial.
60	60	(c) The commissioner by rule shall adopt the form of the
61	61	report required under Subsection (b).
62	62	SECTION 2. Not later than December 31, 2017, the
63	63	commissioner of insurance shall adopt rules as necessary to
64	64	implement Subchapter K, Chapter 38, Insurance Code, as added by
65	65	this Act. The rules must require that an insurer or health benefit
66	66	plan issuer subject to that subchapter make the initial submission
67	67	of the report under that subchapter not later than the 60th day
68	68	after the effective date of the rules.
69	69	SECTION 3. This Act takes effect September 1, 2017.