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80C393(2) PB

80C393(2) PB

 

SECTION ____.  CONFORMING AMENDMENT.  Subtitle A, Title 8, Insurance Code, is amended by adding Chapter 1214 to read as follows:

CHAPTER 1214.  ADVERTISING FOR CERTAIN HEALTH BENEFITS

Revised Law

Sec. 1214.001.  APPLICABILITY OF CHAPTER.  This chapter 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 agreement, a group hospital service contract, or an individual or group evidence of coverage 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; or

(4)  an approved nonprofit health corporation holding a certificate of authority under Chapter 844. (V.T.I.C. Art. 21.20-2, Sec. 1(a).)

Source Law

Art. 21.20-2

Sec. 1.  (a)  This article 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 agreement, a group hospital service contract, or an individual or group evidence of coverage issued by:

(1)  an insurance company;

(2)  a group hospital service corporation operating under Chapter 20 of this code;

(3)  a health maintenance organization operating under the Texas Health Maintenance Organization Act (Chapter 20A, Vernon's Texas Insurance Code); or

(4)  an approved nonprofit health corporation that is certified under Section 5.01(a), Medical Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and that holds a certificate of authority issued by the commissioner under Article 21.52F of this code.

Revisor's Note

Section 1(a)(4), V.T.I.C. Article 21.20-2, refers to a benefit agreement offered by a nonprofit health corporation "certified under Section 5.01(a), Medical Practice Act" and holding a certificate of authority "issued by the commissioner under Article 21.52F." The revised law omits the reference to certification under the Medical Practice Act as unnecessary because V.T.I.C. Article 21.52F, revised in 2001 as Chapter 844, requires a nonprofit health corporation to be certified under the Medical Practice Act as a condition of holding a certificate of authority.  The revised law also omits as unnecessary the reference to the commissioner issuing the certificate of authority because Chapter 844 requires the commissioner to issue the certificate of authority.

Revised Law

Sec. 1214.002.  EXCEPTION.  This chapter does not apply to:

(1)  a plan that provides coverage:

(A)  only for a specified disease;

(B)  only for accidental death or dismemberment; or

(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or

(2)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefits so comprehensive that the policy is a health benefit plan as described by Section 1214.001. (V.T.I.C. Art. 21.20-2, Sec. 1(b).)

Source Law

(b)  This article does not apply to:

(1)  a health benefit plan that provides coverage:

(A)  only for a specified disease;

(B)  only for accidental death or dismemberment; or

(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or

(2)  a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Subsection (a) of this section.

Revisor's Note

Section 1(b)(1), V.T.I.C. Article 21.20-2, refers to a "health benefit plan."  The revised law substitutes "plan" for "health benefit plan" for accuracy.  The plans described by Section 1(b)(1)(C), Article 21.20-2, as providing coverage for certain lost wages may include plans other than health benefit plans.

Revised Law

Sec. 1214.003.  RATE INFORMATION DISCLAIMERS.  (a)  Subject to Chapter 541 and Section 543.001, an advertisement for a health benefit plan may include rate information without including information about each benefit exclusion or limitation if the advertisement includes prominent disclaimers clearly indicating that:

(1)  the rates are illustrative;

(2)  a person should not send money to the health benefit plan issuer in response to the advertisement;

(3)  a person cannot obtain coverage under the plan until the person completes an application for coverage; and

(4)  benefit exclusions or limitations may apply to the plan.

(b)  An advertisement that states a rate must also indicate the age, gender, and geographic location on which the rate is based.  (V.T.I.C. Art. 21.20-2, Sec. 2.)

Source Law

Sec. 2.  (a)  Subject to Article 21.21 of this code, an advertisement for a health benefit plan may include rate information without including information about all benefit exclusions and limitations if the advertisement includes prominent disclaimers that clearly indicate that:

(1)  the rates are illustrative;

(2)  a person should not send money to the issuer of the health benefit plan in response to the advertisement;

(3)  a person cannot obtain coverage under the health benefit plan until the person completes an application for coverage; and

(4)  benefit exclusions and limitations may apply to the health benefit plan.

(b)  Any rate mentioned in the advertisement shall indicate the age, gender, and geographic location on which that rate is based.

TLC: Insurance Code Proposed Chapters
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