| 1 | 1 | | 88R1763 SCL-D |
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| 2 | 2 | | By: Menéndez S.B. No. 451 |
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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 consumer protections for accident and health insurance |
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| 8 | 8 | | that excludes coverage for preexisting conditions. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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| 11 | 11 | | by adding Chapter 1223 to read as follows: |
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| 12 | 12 | | CHAPTER 1223. PREEXISTING CONDITION COVERAGE EXCLUSIONS |
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| 13 | 13 | | SUBCHAPTER A. GENERAL PROVISIONS |
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| 14 | 14 | | Sec. 1223.001. APPLICABILITY OF CHAPTER. This chapter |
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| 15 | 15 | | applies to an individual or group accident and health insurance |
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| 16 | 16 | | policy that excludes coverage for preexisting conditions, |
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| 17 | 17 | | including: |
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| 18 | 18 | | (1) an individual accident and health insurance policy |
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| 19 | 19 | | governed by Chapter 1201; |
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| 20 | 20 | | (2) a group accident and health insurance policy |
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| 21 | 21 | | governed by Chapter 1251; or |
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| 22 | 22 | | (3) a short-term limited-duration insurance policy |
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| 23 | 23 | | governed by Chapter 1509. |
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| 24 | 24 | | Sec. 1223.002. RULES. The commissioner may adopt rules |
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| 25 | 25 | | necessary to implement this chapter. |
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| 26 | 26 | | SUBCHAPTER B. DISCLOSURE AND TERMINATION REQUIREMENTS |
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| 27 | 27 | | Sec. 1223.051. HEALTH INFORMATION DISCLOSURE REQUIRED. (a) |
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| 28 | 28 | | An insurance policy governed by this chapter may not exclude |
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| 29 | 29 | | coverage for a preexisting condition unless the application or |
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| 30 | 30 | | enrollment form for the policy requires disclosure of prior |
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| 31 | 31 | | illness, disease, or physical conditions or of prior medical care |
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| 32 | 32 | | and treatment. |
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| 33 | 33 | | (b) An insurer may not require a disclosure of the health |
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| 34 | 34 | | information of an applicant's or enrollee's family member in an |
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| 35 | 35 | | application or enrollment form for an insurance policy governed by |
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| 36 | 36 | | this chapter unless the family member is also seeking coverage |
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| 37 | 37 | | under the policy. |
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| 38 | 38 | | Sec. 1223.052. TERMINATION REQUIREMENTS. (a) An insurer |
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| 39 | 39 | | may not terminate an insurance policy governed by this chapter |
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| 40 | 40 | | before the expiration date except for: |
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| 41 | 41 | | (1) failure to pay the premium or other applicable |
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| 42 | 42 | | charges for coverage; |
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| 43 | 43 | | (2) material failure to abide by rules, policies, or |
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| 44 | 44 | | procedures of the plan; |
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| 45 | 45 | | (3) fraud or misrepresentation affecting coverage; |
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| 46 | 46 | | (4) a request from the policyholder to cancel |
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| 47 | 47 | | coverage; or |
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| 48 | 48 | | (5) a cause for termination the commissioner |
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| 49 | 49 | | determines is not objectionable. |
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| 50 | 50 | | (b) If an insurer terminates an insurance policy governed by |
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| 51 | 51 | | this chapter before the policy expiration date, the insurer must |
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| 52 | 52 | | send written notice to the insured that includes: |
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| 53 | 53 | | (1) the specific reason the policy was terminated; and |
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| 54 | 54 | | (2) notice that the insured may file a complaint with |
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| 55 | 55 | | the department if the insured believes that the policy was |
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| 56 | 56 | | inappropriately terminated. |
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| 57 | 57 | | SECTION 2. Not later than January 1, 2024, the commissioner |
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| 58 | 58 | | of insurance shall adopt rules necessary to implement Chapter 1223, |
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| 59 | 59 | | Insurance Code, as added by this Act. |
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| 60 | 60 | | SECTION 3. Chapter 1223, Insurance Code, as added by this |
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| 61 | 61 | | Act, applies only to an insurance policy delivered, issued for |
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| 62 | 62 | | delivery, or renewed on or after January 1, 2024. |
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| 63 | 63 | | SECTION 4. This Act takes effect September 1, 2023. |
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