HBA-ATS H.B. 2868 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 2868
By: Capelo
Insurance
4/19/1999
Introduced


BACKGROUND AND PURPOSE 

Article 26.02 (Definitions), Insurance Code, defines a "large employer" as
an employer who employed an average of at least 51 eligible employees on
business days during the preceding calendar year and who employs at least
two eligible employees on the first day of the plan year.  The statutory
definition does not discriminate between large employers who employ fewer
than 200 people.  Yet, some large employer carriers do.  If a large
employer employs fewer than 200 employees, there is a likelihood that its
carrier may not provide it with information related to the total amount of
claims paid by the carrier for each person covered under the plan.  In
contrast, the carrier may provide the same type of information to an
employer who employs more than 200 people if requested to do so by the
employer.  Denial of such information to large employers who employ fewer
than 200 people may prevent that employer from determining the
competitiveness of the premium it is charged. 

H.B. 2868 requires a large employer carrier (carrier), if requested by the
employer, to report to the employer information regarding the total amount
of charges submitted to the carrier for persons covered under the plan; the
total amount of payments made by the carrier to health care providers for
persons covered under the plan; to the extent available, information on
claims paid by type of health care provider, including the total hospital
charges, physician charges, pharmaceutical charges, and other charges; and
the total amount of claims paid by the carrier for each person covered
under the plan.  However, a large employer carrier is not obligated to
release such information if its release violates federal law or regulation. 

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 H, Chapter 26, Insurance Code, by adding
Article 26.96, as follows: 

Art. 26.96.  REPORTING OF CLAIMS INFORMATION.  (a) Sets forth that this
article applies only to an insured large employer health benefit plan
(plan).  

(b) Requires a large employer carrier (carrier), on written request from a
large employer covered by that carrier, to report to the employer
information from the 12 months preceding the date of the report regarding: 

  _the total amount of charges submitted to the carrier for persons covered
under the plan; 
  _the total amount of payments made by the carrier to health care
providers for persons covered under the plan; 
  _to the extent available, information on claims paid by type of health
care provider, including the total hospital charges, physician charges,
pharmaceutical charges, and other charges; and 
  _the total amount of claims paid by the carrier for each person covered
under the plan. 
 
(c) Requires a carrier to provide the requested information annually not
later than the 30th day before the anniversary or renewal date of the
employer's plan. 

(d) Provides that a large employer is not required to provide information
under Subsection (a) earlier than the 30th day after the date of the
initial written request. 

(e) Prohibits a carrier from reporting any required information if the
release is prohibited by federal law or regulation. 

SECTION 2.Effective date: September 1, 1999.
Makes application of this Act prospective for an insured large employer
health benefit plan that is delivered,  issued for delivery, or renewed on
or after January 1, 2000. 

SECTION 3.Emergency clause.