85R9910 SCL-D
By: Campbell S.B. No. 1614
A BILL TO BE ENTITLED
AN ACT
relating to a misleading representation or misrepresentation in an
explanation of benefits provided by a health benefit plan issuer or
administrator.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 541.051, Insurance Code, is amended to
read as follows:
Sec. 541.051. MISREPRESENTATION REGARDING POLICY OR
INSURER. It is an unfair method of competition or an unfair or
deceptive act or practice in the business of insurance to:
(1) make, issue, or circulate or cause to be made,
issued, or circulated an estimate, illustration, circular, or
statement misrepresenting with respect to a policy issued or to be
issued:
(A) the terms of the policy;
(B) the benefits or advantages promised by the
policy; or
(C) the dividends or share of surplus to be
received on the policy;
(2) make a false or misleading statement regarding the
dividends or share of surplus previously paid on a similar policy;
(3) make a misleading representation or
misrepresentation regarding:
(A) the financial condition of an insurer; or
(B) the legal reserve system on which a life
insurer operates;
(4) use a name or title of a policy or class of
policies that misrepresents the true nature of the policy or class
of policies; [or]
(5) make a misrepresentation to a policyholder insured
by any insurer for the purpose of inducing or that tends to induce
the policyholder to allow an existing policy to lapse or to forfeit
or surrender the policy; or
(6) make a misleading representation or
misrepresentation in an explanation of benefits provided by a
health insurer or other health benefit plan issuer or a third-party
administrator of a health benefit plan to an individual covered
under the plan.
SECTION 2. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2017.