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You are here: www.tdi.texas.gov . bulletins . 1997 . b38-7hb3

Summary of Health Care Coverage/Life Related Legislation Enacted - 75th Legislative Session (House Bills Only)

HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 812 (HB 812) relating to Communications between Physicians/Dentists/Providers and Patients/Enrollees and related Contracts SECTION 1 adds Section 18A to Chapter 20A, Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Physician, Dentist, or Provider Communication - An HMO may not, as a condition of a contract with a physician/ dentist/provider, or in any other manner, prohibit/attempt to prohibit/discourage a physician/dentist/provider from discussing with/communicating in good faith to a current/prospective/former patient (or a party designated by a patient) with respect to: (a) information/opinions regarding the patient s health care (including the patient s medical condition or treatment options); (b) information/opinion regarding the provisions/ terms/requirements/services of the health care plan as they relate to the medical needs of the patient; or (c) the fact that the physician s/dentist s/provider s contract with the health care plan has terminated or that the physician/dentist/provider will otherwise no longer be providing medical care/dental care/or health care services under the health care plan - Article 20A, Sec. 18A(a). An HMO may not in any way penalize/ terminate/refuse to compensate for covered services, a physician/dentist/provider for communicating with a current/prospective/former patient (or a party designated by a patient) in any manner protected by this law - Article 20A, Sec. 18A(b). A contract provision that violates this law is void - Article 20A, Sec. 18A(c).

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise as applicable (a) evidence of coverage, applicable documents given to enrollees, quality assurance plans, physician and provider contracts & manuals, (b) any other internal documents, and submit to TDI in accordance with Article 20A. Same as above.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review filings. Take any other necessary action. Same as above.

Applicable Date of Compliance

Applies to a contract entered into or renewed on or after 9/1/97 - SECTION 3 or HB 812.

HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 812 - Continued SECTION 2 adds Sec. 241.1015 to the Health and Safety Code

Effective Date of Statute

Requirements of Statute

Physician Communication and Contracts - A hospital (whether by contract/granting or withholding staff privileges) may not restrict a physician s ability to communicate with a patient with respect to (a) the patient s coverage under a health care plan; (b) any subject related to the medical care or health care services provided including treatment options that are not provided under a health care plan; (c) the availability or desirability of a health care plan/insurance/similar coverage, other than the patient s health care plan; (d) the fact that the physician s staff privileges or contract with a hospital/health care plan have been terminated or that the physician will otherwise no longer be providing care/services at the hospital or under the health care plan - Sec. 241.1015 (a), Health and Safety Code. A contract provision that violates this law is void - Sec. 241.1015(f), Health and Safety Code. For the purpose Sec. 241.1015, the term "health care plan" has the meaning assigned by Article 20A.02.

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance

* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 839 (HB 839) relating to Victims of Family Violence SECTION 1 adds Article 21.21-5 to the Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Scope of Article - This article applies to (1) a life insurer that delivers, issues for delivery, or renews a life insurance contract/policy/certificate; (2) a health benefit plan issuer that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, a health carrier under Chapter 26, an HMO (including an approved nonprofit health corporation under Article 21.52F), a multiple employer welfare arrangement, as defined by Section 3 of the Employee Retirement Income Security Act or another analogous benefit arrangement, or an issuer of a Medicare supplement policy - Article 21.21-5, Sec. 2(a). This article does NOT apply to an issuer of a health benefit plan that provides coverage only for a specified disease, accidental death or dismemberment, disability income, as a supplement to liability insurance, limited benefits, dental or vision care, hospital confinement indemnity coverage, credit insurance, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy; or a long term care policy - Article 21.21-5, Sec. 2(b).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued

Effective Date of Statute

Requirements of Statute

Prohibitions - A health benefit issuer or a life issuer (hereafter referred to as issuer) is prohibited from using an individual s status as a victim of family violence (defined in the bill) to deny coverage to the individual; refuse to renew the individual s coverage; cancel the individual s coverage; limit the amount, extent or kind of coverage available to the individual; or charge the individual or the group to which the individual belongs a different rate. An issuer may not, as part of the application process, require an individual to reveal whether the individual has been or may become a victim of family violence - Article 21.21-5, Sec. 3.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise any and all procedures including, but not limited to, underwriting, rating, marketing and agents training materials to comply with this law. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.

Applicable Date of Compliance

Applies to a policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 3 of HB 839.

HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued

Effective Date of Statute

Requirements of Statute

Sanctions - An issuer who violates this article commits an unfair and deceptive practice under Article 21.21 and is subject to penalties under that article - Article 21.21-5, Sec. 4.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents).

Responsibility of and/or Action Needed by TDI

Investigate alleged violations and take any necessary administrative action.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued

Effective Date of Statute

Requirements of Statute

Release from Liability - An issuer who delivers, issues for delivery or renews a plan or policy for an individual who has been or may become a victim of family violence may not be held civilly or criminally liable for the death of or injuries incurred by that individual as a result of family violence. - Article 21.21-5, Sec. 5.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Inform staff. Revise checklists and other educational materials/brochures.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued

Effective Date of Statute

Requirements of Statute

Underwriting Criteria - An issuer may underwrite a risk based on an individual s physical or mental condition provided the underwriting criteria is not prohibited by this or other law and the issuer consistently applies the criteria and does not use it as a pretext to evade application of Article 21.21-5, Sec. 3 - Article 21.21-5, Sec. 6.

Responsibility of and/or Action Needed by Carriers

Review and revise underwriting, and rating materials, if necessary.

Responsibility of and/or Action Needed by TDI

Inform staff. Revise checklists and other educational materials/brochures. Take any other necessary action.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued

Effective Date of Statute

Requirements of Statute

Continued Coverage - This article does not affect the right of an individual to continue coverage under Article 3.51-6, Sec. 3B - Article 21.21-5, Sec. 7.

Responsibility of and/or Action Needed by Carriers

Inform staff.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued

Effective Date of Statute

Requirements of Statute

Confidentiality - An issuer or any person employed by an issuer may not release information relating to the status of an individual as a victim of family violence. The article lists 8 exceptions to the prohibition to release this information - Article 21.21-5, Sec. 8.

Responsibility of and/or Action Needed by Carriers

Develop/revise procedures for complying with confidentiality and redisclosure requirements.

Responsibility of and/or Action Needed by TDI

Evaluate requests for release of information to parties not listed in new article.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 839 - Continued SECTION 2 amends Article 20A.14(b), Texas Insurance Code

Effective Date of Statute

Requirements of Statute

HMOs subject to Article 21.21-5 - The list of Insurance Code provisions that HMOs must comply with is amended to include Article 21.21-5.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise any and all procedures including, but not limited to, underwriting, rating, marketing and agents training materials to comply with this new article.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.

Applicable Date of Compliance

Applies to a policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 3 of HB 839.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 864 (HB 864) relating to Group Coverage for Certain Students Article 21.24-2 is added to the Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Scope of Article - This article applies to a group health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including a group, blanket, or franchise insurance policy/agreement, a group hospital service contract, or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F), to the extent permitted by the Employee Retirement Income Security Act of 1974, a multiple employer welfare arrangement or another analogous benefit arrangement or any other entity that contracts directly for health care services - Article 21.24-2, Sec. 2(a).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 864- Continued

Effective Date of Statute

Requirements of Statute

This article does NOT apply to a plan that provides coverage only for specified disease, accidental death or dismemberment, for disability income, as a supplement to liability insurance, a plan under Chapter 26, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy, or a long-term care policy - Article 21.24-2. Sec. 2(b).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 864- Continued

Effective Date of Statute

Requirements of Statute

Coverage of Certain Students - Each health benefit plan that conditions dependent coverage (for a child 21 years of age or older) on the child s being a full-time student at an educational institution shall provide the coverage for an entire academic term during which the child begins as a full-time student and remains enrolled, regardless of whether the number of hours of instruction for which the child is enrolled is reduced to a level that changes the child s academic status to less than that of a full-time student. The plan shall provide the coverage continuously until the 10th day of instruction of the subsequent academic term; on which date the plan may terminate coverage of the child if the child does not return to full-time status before that date. Determination of the full-time student status of a child subject to this article is made in the manner provided by the educational institution at which the child is enrolled - Article 21.24-2, Sec. 3.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). if proposed, monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Revise checklists and other educational materials/brochures. Review filings. Take any other necessary action.

Applicable Date of Compliance

Applies to a policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 2 of HB 864.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 1173 (HB 1173) relating to Coverage for Certain Serious Mental Illness SECTION 1 amends Article 3.51-14, Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Scope of Article - This article applies to a group health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including a group insurance policy/agreement, a group hospital service contract or group evidence of coverage that is offered by an insurance company, a group hospital service corporation, an HMO, a fraternal benefit society, a stipulated premium insurance company, and to the extent permitted by the Employee Retirement Income Security Act, a multiple employer welfare or another analogous benefit arrangement - Article 3.51-14, Sec. 2(a). This article does NOT apply to coverage under a blanket accident and health insurance policy, a short-term travel policy, an accident-only policy, a limited or specified-disease policy or a Medicare supplement policy - Article 3.51-14, Sec. 2(b). Definitions - The definition of serious mental illness has been changed by amending the term bipolar disorders to include hypomanic, manic, depressive and mixed and by adding pervasive developmental disorders, obsessive-compulsive disorders and depression in childhood and adolescence - Article 3.51-14, Sec. 1.

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 1173 - Continued

Effective Date of Statute

Requirements of Statute

Required Coverage for Serious Mental Illnesses - A group health benefit plan (a) must provide coverage for 45 days of inpatient treatment, and 60 visits for outpatient treatment, including group and individual outpatient treatment coverage, for serious mental illness in each calendar year; (b) may NOT include a lifetime limit on the number of days of inpatient treatment or the number of outpatient visits covered under the plan; and (c) must include the same amount limits, deductibles, and coinsurance factors for serious mental illness as for physical illness. A group health benefit plan (a) may not count toward the number of outpatient visits required an outpatient visit for the purpose of medication management and (b) must cover that outpatient visit under the same terms and conditions as it covers outpatient visits for treatment of physical illness. An issuer of a group health benefit plan may provide or offer coverage required under this article through a managed care plan - Article 3.51-14, Sec. 3.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agent force). Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Develop and propose rules. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance

Applies to group policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 2 of HB 1173.

HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 1173 - Continued

Effective Date of Statute

Requirements of Statute

Small Employer Coverage - An issuer of a group health benefit plan to a small employer must offer the coverage required for serious mental illness, but is not required to provide the coverage if the small employer rejects the coverage - Article 3.51-14, Sec. 4.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 1173 - Continued

Effective Date of Statute

Requirements of Statute

Certain Benefits Prohibited - This article may not be interpreted to require a group health benefit plan to provide coverage for treatment of (a) addiction to a controlled substance or marihuana that is used in violation of the law or (b) mental illness resulting from the use of a controlled substance or marihuana in violation of the law. Definitions for controlled substance and marihuana are also included in the bill - Article 3.51-14, Sec. 5.

Responsibility of and/or Action Needed by Carriers

Same as above

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 1212 (HB 1212) relating to Health Insurance Portability and Availability and Implementation of Federal Reforms PART 1 (SECTIONS 1.01 - 1.18) RELATING TO SMALL EMPLOYER COVERAGE Amends Articles 26.01-26.02, 26.04, 26.06, 26.13-26.15, 26.21-26.25, 26.33, 26.40 and 26.49 Adds Articles 26.035 and 26.036, 26.21A to the Texas Insurance Code

Effective Date of Statute 7/1/97

Requirements of Statute

Refer to Bulletin #B-0027-97 dated 7/9/97.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Article 20A; and (c) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Proposed rules published in Texas Register on 8/19/97. Hearing scheduled for 10/7/97 at 9:00 A.M., Rm. 100, Hobby Building. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance

Applies to any policy, contract, evidence of coverage issued, delivered or renewed on or after 7/1/97 - SECTION 5.01 of HB 1212.

HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 1212 - Continued PART 2 (SECTION 2.01) relating to Large Employer Coverage Adds Articles 26.81- 26.95 to the Texas Insurance Code

Effective Date of Statute 7/1/97

Requirements of Statute

Refer to Bulletin #B-0027-97 dated 7/9/97.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 1212 - Continued PART 3 (SECTION 3.01) relating to Certification of Creditable Coverage Adds Article 21.52G to the Texas Insurance Code

Effective Date of Statute 7/1/97

Requirements of Statute

Refer to Bulletin #B-0027-97 dated 7/9/97.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) procedures and forms for creditable coverage, (d) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (e) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Proposed rules published in Texas Register on 8/29/97. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 1212 - Continued PART 4 (SECTIONS 4.01-4.05) relating to Multiple Employer Welfare Arrangements Amends Articles 3.95-1, 3.95-8, and 3.95-15 Texas Insurance Code Adds Articles 3.95-1.5 - 3.95-1.7, Articles 3.95-4.1-3.95-4.10 to the Texas Insurance Code

Effective Date of Statute

Requirements of Statute

Refer to Bulletin #B-0027-97 dated 7/9/97.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise or develop as applicable (a) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910 and (b) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance

* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 1865 (HB 1865) relating to Payment of Accelerated Life Insurance Benefits SECTION 1 amends Article 3.50-6, Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Definitions - The following terms are added and defined in the statute: long-term care illness, specified disease and terminal illness - Article 3.50-6(a). Payment of accelerated death benefits - The statute now allows for payment of an accelerated benefit under an individual or group term policy or certificate if a written medical opinion record is received by the company that the insured has a terminal illness, long-term care illness or a specified disease - Article 3.50-6(b). Rules - The commissioner may adopt rules to implement this article - Article 3.50-6(c).

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) life forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Develop and propose rules. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance

Applies to any policy or contract that is delivered, issued for delivery or renewed on or after 9/1/97 - SECTION 2 of HB 1865.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 2015 (HB 2015) relating to Redesignation of Articles 21.79E, Texas Insurance Code SECTIONS 1 and 2 redesignate the 21.79E Articles

Effective Date of Statute 9/1/97

Requirements of Statute

SECTION 1 - Article 21.79E relating to Illegal Pricing Practices is redesignated as Article 21.79F. SECTION 2 - Article 21.79E relating to Action for Amount of Deductible is redesignated as Article 21.79G.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). Revise any internal documents/checklists.

Responsibility of and/or Action Needed by TDI

Inform staff. Develop/revise checklists and other educational materials/brochures. Take any other necessary action.

Applicable Date of Compliance

9/1/97
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 2017 (HB 2017) relating to Telemedicine Services Provided under the Medicaid and Medicare Programs (Refer also to HB 2033) SECTION 1 adds Sec. 531.0215 to the Government Code

Effective Date of Statute 6/20/97

Requirements of Statute

Participation and reimbursement of Telemedicine Service Providers under Medicaid - The Health and Human Services Commission (THHSC) by rule shall develop and implement a system to reimburse providers of services under the state Medicaid program for services performed using telemedicine. The bill outlines what the commission shall consider in developing the system. Additionally the commission is to encourage the listed entities to participate as telemedicine providers - Sec. 531.0215, Government Code.

Responsibility of and/or Action Needed by Carriers

Inform staff.

Responsibility of and/or Action Needed by TDI

Inform staff. Monitor development and adoption of rules by THHSC.

Applicable Date of Compliance

6/20/97 - SECTION 4 of HB 2017.

HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 2017 - Continued SECTION 2 adds Section 5.11 to the Medical Practice Act.

Effective Date of Statute

Requirements of Statute

Rules regarding telemedicine services - The Board of Medical Examiners (TSBME), in consultation with the THHSC and the Commissioner of Insurance, may adopt rules as necessary to (a) ensure that appropriate care is provided to Medicaid and Medicare patients who receive services that are provided through telemedicine; and (b) prevent abuse and fraud in the use of telemedicine services for Medicaid and Medicare patients (including rules relating to filing of claims and records required to be maintained in relation to telemedicine) - Sec. 5.11, Medical Practice Act.

Responsibility of and/or Action Needed by Carriers

Inform staff. Monitor development and adoption of rules.

Responsibility of and/or Action Needed by TDI

Inform staff. Coordinate with TSBME & THHSC in development/ adoption of rules. Take any other necessary action.

Applicable Date of Compliance

* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HOUSE BILL 2033 (HB 2033) relating to Coverage for Service Provided through Telemedicine SECTION 1 adds Article 21.53F to the Texas Insurance Code

Effective Date of Statute 9/1/97

Requirements of Statute

Scope of Article - This article applies 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/agreement, a group hospital service contract or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F) or to the extent permitted by the Employee Retirement Income Security Act, a multiple employer welfare arrangement, or another analogous benefit arrangement - Article 21.53F, Sec. 2(a).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance


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NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 2033 - Continued

Effective Date of Statute

Requirements of Statute

This article does NOT apply to a plan that provides coverage only for a specified disease, accidental death or dismemberment; disability income, as a supplement to liability insurance, a small employer health plan under Chapter 26, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy; or a long term care policy - Article 21.53F, Sec. 2(b).

Responsibility of and/or Action Needed by Carriers

Responsibility of and/or Action Needed by TDI

Applicable Date of Compliance


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NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 2033 - Continued

Effective Date of Statute

Requirements of Statute

Coverage for Telemedicine Services - A health benefit plan may not exclude a service from coverage solely because the service is provided through telemedicine and not provided through a face-to-face consultation. (The term "telemedicine is defined in the bill.) Benefits for a service provided through telemedicine may be made subject to a deductible, copayment, or coinsurance requirement; however, the deductible, copayment, or coinsurance may not exceed that required by the plan for the same service provided through a face-to-face consultation - Article 21.53F, Sec. 3.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). If proposed, monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.

Responsibility of and/or Action Needed by TDI

Inform staff. Evaluate and propose rules, if necessary. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.

Applicable Date of Compliance

Applies to any policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 2 of HB 2033.

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NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 2033 - Continued

Effective Date of Statute

Requirements of Statute

Informed Consent - A treating physician/other health care provider who provides or facilitates the use of telemedicine shall ensure that the informed consent of the patient (or another appropriate person with authority to make health care treatment decisions for the patient) is obtained before services are provided through telemedicine - Article 21.53F, Sec. 4.

Responsibility of and/or Action Needed by Carriers

Inform staff (including agents). Monitor development and adoption of rules.

Responsibility of and/or Action Needed by TDI

Inform staff. Coordinate with TSBME in development and proposal of rules. Develop/revise checklists and other educational materials/brochures. Take any other necessary action.

Applicable Date of Compliance


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NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 2033 - Continued

Effective Date of Statute

Requirements of Statute

Confidentiality - A treating physician/ other health care provider who provides or facilitates the use of telemedicine shall ensure that the confidentiality of the patient s medical information is maintained as required by Section 5.08, Medical Practice Act or other applicable law - Article 21.53F, Sec. 5.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance


HB Index SB Index Previous Bill Next Bill

NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.

HB 2033 - Continued

Effective Date of Statute

Requirements of Statute

Rules - The commissioner in consultation with the TSBME, may adopt rules to ensure appropriate care is provided to patients who receive services through telemedicine and (b) prevent abuse and fraud through the use of telemedicine services - Article 21.53F, Sec. 6.

Responsibility of and/or Action Needed by Carriers

Same as above.

Responsibility of and/or Action Needed by TDI

Same as above.

Applicable Date of Compliance

* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
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Last updated: 09/06/2014

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