HBA-TYH C.S.H.B. 1097 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1097 By: Coleman Insurance 4/22/1999 Committee Report (Substituted) 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. C.S.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, rather than simply providing evidence, the individual provides the following information to the pool: (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, 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). Make 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. COMPARISON OF ORIGINAL TO SUBSTITUTE The substitute modifies the original bill in SECTION 1 (Section 10(a), Article 3.77, Insurance Code) by allowing an individual to be eligible for coverage from the pool if the individual submits the specified information to the pool, rather than the board. The substitute modifies the original bill in SECTION 1 (Section 10(a)(1), Article 3.77, Insurance Code) by allowing the individual to provide to the pool for eligibility consideration 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. The substitute modifies the original bill in SECTION 1 (Section 10(a)(2), Article 3.77, Insurance Code) by adding completely new text to allow the individual to provide to the pool for eligibility consideration a certification from an agent or salaried representative of an insurer, on a form developed by the board and approved by the commissioner, 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: this subdivision of the original bill allows the individual to provide to the board of directors for eligibility consideration 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. The substitute modifies the original bill in SECTION 1 (Sections 10(a)(3) and (4), Article 3.77, Insurance Code) to make conforming changes. The substitute modifies the original bill in SECTION 1 (Section 10(a)(6), Article 3.77, Insurance Code) by allowing the individual to provide to the pool for eligibility consideration, 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, "without applying for health insurance coverage").