Bill Text: TX HB3064 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to payment of health benefit claims in coordination with third-party liability insurance.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-04-30 - Committee report sent to Calendars [HB3064 Detail]
Download: Texas-2019-HB3064-Introduced.html
| 86R11586 SCL-D | ||
| By: J. Johnson of Dallas | H.B. No. 3064 | |
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| relating to payment of health benefit claims in coordination with | ||
| third-party liability insurance. | ||
| 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. THIRD-PARTY LIABILITY INSURANCE | ||
| Sec. 1203.101. DEFINITIONS. In this subchapter: | ||
| (1) "Enrollee" means an individual who is eligible for | ||
| coverage under a health benefit plan, including a covered | ||
| dependent. | ||
| (2) "Health benefit plan" means a group, blanket, or | ||
| franchise insurance policy, a group hospital service contract, or a | ||
| group subscriber contract or evidence of coverage issued by a | ||
| health maintenance organization, that provides benefits for health | ||
| care services. | ||
| (3) "Health benefit plan issuer" means an entity | ||
| authorized under this code or another insurance law of this state | ||
| that provides health insurance or health benefits in this state. | ||
| Sec. 1203.102. 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) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) group health coverage made available by a school | ||
| district in accordance with Section 22.004, Education Code; | ||
| (9) the state Medicaid program, including the Medicaid | ||
| managed care program operated under Chapter 533, Government Code; | ||
| (10) the child health plan program under Chapter 62, | ||
| Health and Safety Code; | ||
| (11) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; | ||
| (12) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code; | ||
| (13) county employee group health benefits provided | ||
| under Chapter 157, Local Government Code; and | ||
| (14) health and accident coverage provided by a risk | ||
| pool created under Chapter 172, Local Government Code. | ||
| Sec. 1203.103. DELAY OF PAYMENT PROHIBITED. A health | ||
| benefit plan issuer may not delay payment of a claim or provision of | ||
| coverage for a benefit under the issuer's health benefit plan on the | ||
| basis that the enrollee may be eligible to recover under a third | ||
| party's liability insurance policy. | ||
| SECTION 2. Section 1203.103, Insurance Code, as added by | ||
| this Act, applies only to a health benefit plan delivered, issued | ||
| for delivery, or renewed on or after January 1, 2020. A health | ||
| benefit plan delivered, issued for delivery, or renewed before | ||
| January 1, 2020, is governed by the law as it existed immediately | ||
| before the effective date of this Act, and that law is continued in | ||
| effect for that purpose. | ||
| SECTION 3. This Act takes effect September 1, 2019. | ||
