80C77(2) PEP

 

CHAPTER 1550. CERTAIN REQUIREMENTS FOR INSURERS CONTRACTING

WITH GOVERNMENTAL ENTITIES

SUBCHAPTER A.  REPORTING REQUIREMENTS

Revised Law

Sec. 1550.001.  DEFINITIONS.  In this subchapter:

(1)  "Governmental entity" means:

(A)  a state agency; or

(B)  a county, municipality, school district, special purpose district, or other subdivision of state government that has jurisdiction limited to a geographic portion of the state.

(2)  "Insurer" means:

(A)  an insurance company;

(B)  a health maintenance organization operating under Chapter 843; or

(C)  an approved nonprofit health corporation that holds a certificate of authority issued under Chapter 844.  (V.T.I.C. Art. 21.49-15, Sec. 1.)

Source Law

Art. 21.49-15

Sec. 1.  In this article:

(1)  "Governmental entity" means a state agency or political subdivision of this state.

(2)  "Insurer" means:

(A)  an insurance company;

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

(C)  an approved nonprofit health corporation that holds a certificate of authority issued by the commissioner under Article 21.52F of this code.

(3)  "Political subdivision" means a county, municipality, school district, special purpose district, or other subdivision of state government that has jurisdiction limited to a geographic portion of the state.

Revisor's Note

Section 1(2), V.T.I.C. Article 21.49-15, refers to an approved nonprofit health corporation that holds a certificate of authority "issued by the commissioner" under V.T.I.C. Article 21.52F.  The revised law omits the quoted language as unnecessary because only the commissioner is authorized to issue a certificate of authority under Article 21.52F, revised as Chapter 844 of this code.

Revised Law

Sec. 1550.002.  REPORT REQUIRED.  (a)  This section applies to a contract subject to competitive bidding under which an insurer delivers, issues for delivery, or renews a health insurance policy or contract or an evidence of coverage.

(b)  An insurer that enters into a contract described by Subsection (a) with a governmental entity shall provide to the governmental entity a detailed report that includes:

(1)  the claims experience of the governmental entity during the preceding calendar year;  and

(2)  the dollar amount of each large claim, as defined by the governmental entity, paid by the insurer under the contract during the preceding calendar year.  (V.T.I.C. Art. 21.49-15, Sec. 2(a).)

Source Law

Sec. 2.  (a)  Each insurer that enters into a contract with a governmental entity that is subject to competitive bidding requirements and under which the insurer delivers, issues for delivery, or renews a policy or contract for health insurance or an evidence of coverage shall provide to the governmental entity a detailed report that includes:

(1)  the claims experience of the governmental entity during the preceding calendar year; and

(2)  the dollar amount of each large claim, as defined by the governmental entity, paid by the insurer under the contract during the preceding calendar year.

Revised Law

Sec. 1550.003.  CLAIM INFORMATION.  (a)  An insurer providing claim information to a governmental entity in the report under Section 1550.002 shall provide the information in the aggregate, without information through which a specific individual covered by the health insurance or evidence of coverage may be identified.

(b)  Claim information provided by an insurer to a governmental entity in the report under Section 1550.002:

(1)  may be viewed or used only for contract bidding purposes; and

(2)  is confidential for purposes of Chapter 552, Government Code.  (V.T.I.C. Art. 21.49-15, Sec. 2(b).)

Source Law

(b)  Claim information provided by an insurer to the governmental entity under this section:

(1)  shall be provided in the aggregate, without information through which a specific individual covered by the health insurance or evidence of coverage may be identified;

(2)  may be viewed or used only for contract bidding purposes;  and

(3)  is confidential for purposes of Chapter 552, Government Code.

[Sections 1550.004-1550.050 reserved for expansion]

SUBCHAPTER B.  CERTAIN CONTRACTS

WITH MUNICIPALITIES

Revised Law

Sec. 1550.051.  DEFINITION OF INSURER.  In this subchapter, "insurer" means:

(1)  an insurance company, including a company providing stop-loss or excess loss insurance;

(2)  a health maintenance organization operating under Chapter 843;

(3)  an approved nonprofit health corporation that holds a certificate of authority issued under Chapter 844; or

(4)  a third-party administrator that holds a certificate of authority under Chapter 4151.  (V.T.I.C. Art. 21.49-16, Sec. 1(1).)

Source Law

Art. 21.49-16

Sec. 1.  In this article:

(1)  "Insurer" means:

(A)  an insurance company, including a company providing stop-loss or excess loss insurance;

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

(C)  an approved nonprofit health corporation that holds a certificate of authority issued by the commissioner under Article 21.52F of this code; or

(D)  a third party administrator that holds a certificate of authority under Article 21.07-6 of this code.

Revisor's Note

Section 1(1), V.T.I.C. Article 21.49-16, refers to an approved nonprofit health corporation that holds a certificate of authority "issued by the commissioner" under V.T.I.C. Article 21.52F.  For the reason stated in the revisor's note to Section 1550.001, the revised law omits the quoted language as unnecessary.

Revised Law

Sec. 1550.052.  BID REQUIREMENTS.  (a)  Except as provided by Section 1550.054, an insurer that bids on a contract subject to the competitive bidding and competitive proposal requirements adopted under Section 252.021, Local Government Code, may not submit a bid for a contract to provide stop-loss or other insurance coverage that is subject to any qualification imposed by the insurer that permits the insurer to modify or limit the terms of insurance coverage to be provided after the contract has been made. 

(b)  An insurer's bid submitted under Section 252.021, Local Government Code, must contain the insurer's entire offer.  (V.T.I.C. Art. 21.49-16, Sec. 2(a).)

Source Law

Sec. 2.  (a)  Except as provided by Subsection (c) of this section, an insurer who bids on a contract subject to the competitive bidding and competitive proposal requirements adopted under Section 252.021, Local Government Code, may not submit a bid for a contract to provide stop-loss or other insurance coverage that is subject to any qualification imposed by the insurer that permits the insurer to modify or limit the terms of insurance coverage to be provided after the contract has been made.  An insurer's bid submitted under Section 252.021, Local Government Code, must contain the entire offer made by the insurer.

Revised Law

Sec. 1550.053.  CERTAIN EXCLUSIONS AND INCREASED DEDUCTIBLES PROHIBITED.  Except as provided by Section 1550.054, an insurer that provides stop-loss or other insurance coverage for health benefits under a contract subject to this subchapter may not, based on an individual's prior medical history:

(1)  exclude from coverage an individual who is otherwise eligible for the health benefits coverage; or

(2)  assign a higher deductible to the individual.  (V.T.I.C. Art. 21.49-16, Sec. 2(b).)

Source Law

(b)  Except as provided by Subsection (c) of this section, an insurer who provides stop-loss or other insurance coverage for health benefits under a contract subject to this article may not, based on an individual's prior medical history, exclude an individual who is otherwise eligible for the health benefits coverage from coverage or assign a higher deductible to the individual.

Revised Law

Sec. 1550.054.  EXCEPTION FOR WRITTEN WAIVER.  By executing a written waiver in favor of the insurer, a municipality as defined by Section 1.005, Local Government Code, may waive a requirement of Section 1550.052 or 1550.053(2).  (V.T.I.C. Art. 21.49-16, Secs. 1(2), 2(c).)

Source Law

[Sec. 1]

(2)  "Municipality" has the meaning assigned by Section 1.005, Local Government Code.

[Sec. 2]

(c)  By executing a written waiver in favor of the insurer, a municipality may waive the requirements of:

(1)  Subsection (a) of this section; or

(2)  Subsection (b) of this section regarding the assignment of a higher deductible to the individual.