| 1 | 1 | | 85R9910 SCL-D |
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| 2 | 2 | | By: Campbell S.B. No. 1614 |
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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 a misleading representation or misrepresentation in an |
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| 8 | 8 | | explanation of benefits provided by a health benefit plan issuer or |
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| 9 | 9 | | administrator. |
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| 10 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 11 | | SECTION 1. Section 541.051, Insurance Code, is amended to |
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| 12 | 12 | | read as follows: |
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| 13 | 13 | | Sec. 541.051. MISREPRESENTATION REGARDING POLICY OR |
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| 14 | 14 | | INSURER. It is an unfair method of competition or an unfair or |
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| 15 | 15 | | deceptive act or practice in the business of insurance to: |
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| 16 | 16 | | (1) make, issue, or circulate or cause to be made, |
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| 17 | 17 | | issued, or circulated an estimate, illustration, circular, or |
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| 18 | 18 | | statement misrepresenting with respect to a policy issued or to be |
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| 19 | 19 | | issued: |
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| 20 | 20 | | (A) the terms of the policy; |
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| 21 | 21 | | (B) the benefits or advantages promised by the |
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| 22 | 22 | | policy; or |
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| 23 | 23 | | (C) the dividends or share of surplus to be |
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| 24 | 24 | | received on the policy; |
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| 25 | 25 | | (2) make a false or misleading statement regarding the |
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| 26 | 26 | | dividends or share of surplus previously paid on a similar policy; |
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| 27 | 27 | | (3) make a misleading representation or |
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| 28 | 28 | | misrepresentation regarding: |
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| 29 | 29 | | (A) the financial condition of an insurer; or |
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| 30 | 30 | | (B) the legal reserve system on which a life |
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| 31 | 31 | | insurer operates; |
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| 32 | 32 | | (4) use a name or title of a policy or class of |
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| 33 | 33 | | policies that misrepresents the true nature of the policy or class |
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| 34 | 34 | | of policies; [or] |
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| 35 | 35 | | (5) make a misrepresentation to a policyholder insured |
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| 36 | 36 | | by any insurer for the purpose of inducing or that tends to induce |
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| 37 | 37 | | the policyholder to allow an existing policy to lapse or to forfeit |
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| 38 | 38 | | or surrender the policy; or |
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| 39 | 39 | | (6) make a misleading representation or |
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| 40 | 40 | | misrepresentation in an explanation of benefits provided by a |
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| 41 | 41 | | health insurer or other health benefit plan issuer or a third-party |
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| 42 | 42 | | administrator of a health benefit plan to an individual covered |
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| 43 | 43 | | under the plan. |
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| 44 | 44 | | SECTION 2. This Act takes effect immediately if it receives |
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| 45 | 45 | | a vote of two-thirds of all the members elected to each house, as |
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| 46 | 46 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 47 | 47 | | Act does not receive the vote necessary for immediate effect, this |
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| 48 | 48 | | Act takes effect September 1, 2017. |
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