Bill Text: TX HB2630 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to the reporting of certain claims information by certain insurers and health benefit plan issuers to the Texas Department of Insurance.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2017-03-21 - Referred to Insurance [HB2630 Detail]
Download: Texas-2017-HB2630-Introduced.html
| 85R10998 SMT-D | ||
| By: Muñoz, Jr. | H.B. No. 2630 | |
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| relating to the reporting of certain claims information by certain | ||
| insurers and health benefit plan issuers to the Texas Department of | ||
| Insurance. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 38, Insurance Code, is amended by adding | ||
| Subchapter K to read as follows: | ||
| SUBCHAPTER K. CLAIM REPORTING BY CERTAIN INSURERS AND HEALTH | ||
| BENEFIT PLAN ISSUERS | ||
| Sec. 38.501. CLAIM REPORTING REQUIREMENTS. (a) In this | ||
| section: | ||
| (1) "Health benefit plan issuer" means the issuer of 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 | ||
| policy or insurance agreement, a group hospital service contract, | ||
| or an evidence of coverage or similar coverage document. The term | ||
| includes: | ||
| (A) a plan issued by: | ||
| (i) an insurer; | ||
| (ii) a health maintenance organization | ||
| operating under Chapter 843; or | ||
| (iii) a group hospital service corporation | ||
| operating under Chapter 842; | ||
| (B) notwithstanding any provision in Chapter | ||
| 1551, 1575, 1579, or 1601: | ||
| (i) a basic coverage plan under Chapter | ||
| 1551; | ||
| (ii) a basic plan under Chapter 1575; | ||
| (iii) a primary care coverage plan under | ||
| Chapter 1579; or | ||
| (iv) basic coverage under Chapter 1601; | ||
| (C) group health coverage made available by a | ||
| school district in accordance with Section 22.004, Education Code; | ||
| (D) coverage provided under the state Medicaid | ||
| program, including the Medicaid managed care program operated under | ||
| Chapter 533, Government Code; and | ||
| (E) coverage provided under the child health plan | ||
| program under Chapter 62, Health and Safety Code. | ||
| (2) "Insurer" means an insurance company, reciprocal | ||
| or interinsurance exchange, mutual insurance company, capital | ||
| stock company, county mutual insurance company, Lloyd's plan, or | ||
| other legal entity authorized to engage in the business of | ||
| insurance in this state. | ||
| (b) An insurer engaged in the business of personal | ||
| automobile or residential property insurance or a health benefit | ||
| plan issuer shall submit a quarterly report to the department | ||
| containing the following information organized by zip code: | ||
| (1) the number of claims filed with the insurer under | ||
| personal automobile or residential property insurance policies, as | ||
| applicable, or the number of health benefit claims filed with the | ||
| health benefit plan issuer; | ||
| (2) the number of claims denied; and | ||
| (3) for each claim denied, the reason for the denial. | ||
| (c) The commissioner by rule shall adopt the form of the | ||
| report required under Subsection (b). | ||
| SECTION 2. Not later than December 31, 2017, the | ||
| commissioner of insurance shall adopt rules as necessary to | ||
| implement Subchapter K, Chapter 38, Insurance Code, as added by | ||
| this Act. The rules must require that an insurer or health benefit | ||
| plan issuer subject to that subchapter make the initial submission | ||
| of the report under that subchapter not later than the 60th day | ||
| after the effective date of the rules. | ||
| SECTION 3. This Act takes effect September 1, 2017. | ||
