HBA-NMO H.B. 256 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 256 By: Pitts Insurance 2/10/1999 Introduced BACKGROUND AND PURPOSE Currently, health benefit plans are not required to print copayment information on their enrollee's identification cards. This may create confusion in determining payment amounts for the enrollee, physician, hospital, or pharmacist. H.B. 256 requires each health benefit plan to print on each enrollee's identification card the amount of each applicable copayment. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.52H, as follows: Article 21.52H. COPAYMENT INFORMATION ON HEALTH COVERAGE IDENTIFICATION CARDS Sec. 1. DEFINITION. Defines "health benefit plan." Sec. 2. SCOPE OF ARTICLE. (a) Provides that this article applies only to a health benefit plan (plan) that: (1) is an insurance policy or agreement, a group hospital service contract, or an individual or group evidence of coverage offered by an insurance company, a group hospital service corporation (Chapter 20, Insurance Code), a fraternal benefit society (Chapter 10), a stipulated premium insurance company (Chapter 22), or a health maintenance organization (Chapter 20A); or to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a plan that is offered by a multiple employer welfare arrangement, any other non-licensed entity that contracts directly for health care services on a risk-sharing basis, including an entity that contracts for health care services on a capitation basis, or another similar benefit arrangement; (2) is offered by an approved nonprofit health corporation that is certified under Section 5.01(a), Medical Practice Act (Article 4495b, V.T.C.S., Certification of Certain Organizations), and that holds a certificate of authority issued by the Commissioner of Insurance (commissioner) under Article 21.52F, Insurance Code (Certification of Certain Nonprofit Health Corporations); or (3) is a small employer plan written under Chapter 26, Insurance Code (Health Insurance Availability); or (4) is offered through a Medicare supplement policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss). (b) Provides that this article does not apply to: (1) a plan that provides coverage only for a specified disease or other limited benefit, only for accidental death or dismemberment, for lost wages because of sickness or injury, as a supplement to liability insurance, for credit insurance, only for dental or vision care, or only for indemnity for hospital confinement or other hospital expenses; (2) workers' compensation insurance coverage; (3) medical payment insurance issued as part of a motor vehicle insurance policy; or (4) a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Subsection (a). Sec. 3. COPAYMENT INFORMATION. Requires each plan that issues a health coverage identification card or similar item to an insured, beneficiary, or enrollee covered under the plan to include in the information printed on the card or similar item a statement of each type and amount of copayment assessed under the plan, including copayments for office visits; emergency room care; and pharmaceutical coverage, including copayments for generic and brand-name prescriptions. SECTION 2. Makes application of this Act prospective to January 1, 2000. SECTION 3. Effective date: September 1, 1999. SECTION 4. Emergency clause.