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


Office of House Bill AnalysisH.B. 1097
By: Coleman
Insurance
3/11/1999
Introduced



BACKGROUND AND PURPOSE 

The Texas Health Insurance Risk Pool (pool) was established by the 71st
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.  One method requires applicants to provide
evidence of a notice of rejection or refusal to issue substantially similar
insurance for health reasons by two insurers.  Most health plans charge an
application fee before they issue a refusal or rejection.  These fees are a
burden to some applicants and the applicant is left with the choice of
paying the fees or forgoing participation in the pool. 

H.B. 1097 allows a pool applicant to establish eligibility by providing
copies of two insurance plans that are substantially similar to the plan
offered by the pool that the applicant would have qualified for if not for
the diagnosed medical condition.  Applicants would also have to submit
certified copies of their medical records documenting their pre-existing
condition. 

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, rather than simply providing evidence, the individual
provides the following enumerated information to the board of directors of
the pool: 

(1)  a notice of rejection or refusal to issue substantially 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) copies of the requirements of two insurance plans that are
substantially similar to the plan offered by the pool, other than plans
offering only stop-loss, excess loss, or reinsurance coverage, and a
certified copy of the individual's medical record showing a pre-existing
condition that together demonstrate the strong probability for refusal of
individual's coverage under those insurance plans. 

Redesignates Subdivisions (2)-(5) to (3)-(6).  Makes conforming and
nonsubstantive changes. 

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

SECTION 3. Emergency clause.