HBA-TYH H.B. 1097 76(R)BILL ANALYSIS


Office of House Bill AnalysisH.B. 1097
By: Coleman
Insurance
6/3/1999
Enrolled



BACKGROUND AND PURPOSE 

The Texas Health Insurance Risk Pool (pool) was established by the 71st
Texas Legislature to provide medically uninsurable Texans with access to
quality health care.  There are several ways Texas residents may become
eligible for coverage through the pool.  H.B. 1097 allows a pool applicant
to establish eligibility by providing to the pool a notice of refusal to
issue substantially similar individual insurance for health reasons by one
insurer, a certification from an agent or salaried representative of an
insurer that states that the agent or salaried representative is unable to
obtain substantially similar individual insurance for the individual
because the individual will be declined for coverage as a result of a
medical condition of the individual, or a diagnosis of the individual with
one of the medical or health conditions listed by the board of directors of
the pool for which a person shall be eligible for pool coverage, among
other specified information. 

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 Section 10(a), Article 3.77, Insurance Code, to require
a person to be eligible for coverage from the Texas Health Insurance Risk
Pool (pool) if the individual provides the following information to the
pool, rather than simply providing evidence of: 

(1)  a notice of rejection or refusal to issue substantially similar
individual insurance for health reasons by one insurer, rather than similar
insurance for health reasons by two insurers, other than a rejection or
refusal by an insurer offering only stop-loss, excess loss, or reinsurance
coverage; 

(2)  a certification from an agent or salaried representative of an
insurer, on a form developed by the board of directors of the pool (board)
and approved by the commissioner of insurance, that states that the agent
or salaried representative is unable to obtain substantially similar
individual insurance for the individual with any state-licenced insurer
that the agent or salaried representative represents because the individual
will be declined for coverage as a result of a medical condition of the
individual under the underwriting guidelines of the insurer; or 

(3)-(5)  Redesignated from Subdivisions (2)-(4).  Makes conforming changes.

(6)  diagnosis of the individual with one of the medical or health
conditions listed by the board for which a person shall be eligible for
pool coverage (deletes the exception of without applying for health
insurance coverage). 

SECTION 2. Effective date: September 1, 1999.
  Makes application of this Act prospective.

SECTION 3. Emergency clause.