Bill Text: TX HB1253 | 2011-2012 | 82nd Legislature | Engrossed


Bill Title: Relating to certain modifications of a health benefit plan.

Spectrum: Slight Partisan Bill (Republican 3-1)

Status: (Engrossed - Dead) 2011-05-05 - Referred to State Affairs [HB1253 Detail]

Download: Texas-2011-HB1253-Engrossed.html
  82R20189 RWG-F
 
  By: Smithee, Hardcastle, Eiland, Nash H.B. No. 1253
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to certain modifications of a health benefit plan.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subchapter B, Chapter 1369, Insurance Code, is
  amended by adding Section 1369.0541 to read as follows:
         Sec. 1369.0541.  MODIFICATION OF DRUG COVERAGE UNDER PLAN.
  (a)  In addition to applying to a group health benefit plan to which
  this subchapter applies, this section applies to an individual
  health benefit plan, as defined by Section 544.501.
         (b)  Notwithstanding Section 1369.053, this section applies
  to a small employer health benefit plan written under Chapter 1501.
         (c)  A group or individual health benefit plan issuer may
  modify drug coverage provided under a health benefit plan if:
               (1)  the modification occurs at the time of coverage
  renewal;
               (2)  the modification is effective uniformly among all
  group health benefit plan sponsors covered by identical or
  substantially identical health benefit plans or all individuals
  covered by identical or substantially identical individual health
  benefit plans, as applicable; and
               (3)  not later than the 60th day before the date the
  modification is effective, the issuer provides written notice of
  the modification to the commissioner, each affected group health
  benefit plan sponsor, each affected enrollee in an affected group
  health benefit plan, and each affected individual health benefit
  plan holder.
         (d)  Modifications affecting drug coverage that require
  notice under Subsection (c) include:
               (1)  removing a drug from a formulary;
               (2)  adding a requirement that an enrollee receive
  prior authorization for a drug;
               (3)  imposing or altering a quantity limit for a drug;
               (4)  imposing a step-therapy restriction for a drug;
  and
               (5)  moving a drug to a higher cost-sharing tier unless
  a generic drug alternative to the drug is available.
         (e)  A group or individual health benefit plan issuer may
  elect to offer an enrollee in the plan the option of receiving
  notifications required by this section by e-mail.
         SECTION 2.  Section 1501.108(d), Insurance Code, is amended
  to read as follows:
         (d)  Notwithstanding Subsection (a), a small or large
  employer health benefit plan issuer may modify a small or large
  employer health benefit plan in accordance with Section 1369.0541
  or if:
               (1)  the modification occurs at the time of coverage
  renewal;
               (2)  the modification is effective uniformly among all
  small or large employers covered by that health benefit plan; and
               (3)  the issuer notifies the commissioner and each
  affected covered small or large employer of the modification not
  later than the 60th day before the date the modification is
  effective.
         SECTION 3.  This Act takes effect September 1, 2011.
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