88R10352 KBB-D
By: Harris of Williamson H.B. No. 4501
A BILL TO BE ENTITLED
AN ACT
relating to a uniform coordination of benefits questionnaire for
health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1203, Insurance Code, is amended by
adding Subchapter C to read as follows:
SUBCHAPTER C. COORDINATION OF BENEFITS QUESTIONNAIRE
Sec. 1203.101. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to 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 insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(10) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(11) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 533,
Government Code;
(12) the child health plan program under Chapter 62,
Health and Safety Code;
(13) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(14) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(15) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(16) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1203.102. CREATION OF UNIFORM COORDINATION OF BENEFITS
QUESTIONNAIRE. In collaboration with appropriate stakeholders,
the commissioner shall adopt rules establishing a uniform
coordination of benefits questionnaire to be used by all health
benefit plan issuers and administrators in this state.
Sec. 1203.103. UNIFORM COORDINATION OF BENEFITS
QUESTIONNAIRE REQUIRED. Each health benefit plan issuer and
administrator shall use the uniform coordination of benefits
questionnaire established under Section 1203.102 and make the
questionnaire available to health care providers as appropriate.
SECTION 2. (a) Not later than January 1, 2024, the
commissioner of insurance shall adopt rules establishing the
uniform coordination of benefits questionnaire under Section
1203.102, Insurance Code, as added by this Act.
(b) The changes in law made by this Act apply only to the use
of a coordination of benefits questionnaire on or after February 1,
2024.
SECTION 3. This Act takes effect September 1, 2023.