HBA-TYH H.B. 1628 76(R)BILL ANALYSIS Office of House Bill AnalysisH.B. 1628 By: Maxey Insurance 7/12/1999 Enrolled BACKGROUND AND PURPOSE Governmental entities (entities) must make competitive bids for health insurance each year. In order to have a fair and efficient bid process, bidders need claims experience data from the entities. In the past, entities' current insurers have withheld the needed claims experience and consequently have hampered the bidding process. H.B. 1628 requires insurers to provide the entities and employers with reports that include claims experience for the previous year and the dollar amount of each large claim paid by the insurer in the previous year. 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 21.49-15, as follows: Art. 21.49-15. INFORMATION REQUIRED TO BE PROVIDED BY INSURER TO GOVERNMENTAL ENTITY WITH WHICH INSURER CONTRACTS Sec. 1. DEFINITIONS. Defines "governmental entity," "insurer," and "political subdivision" for this article. Sec. 2. REQUIRED INFORMATION. (a) Requires each insurer that enters into a contract with a governmental entity (entity) that is subject to competitive bidding requirements to provide to the entity a detailed report that includes: _the claims experience of the entity during the preceding calendar year; and _the dollar amount of each large claim, as defined by the entity, paid by the insurer under the contract during the preceding calendar year. (b) Provides that claim information provided by an insurer to the entity under this section: is required to be provided in the aggregate, without information through which a specific individual covered by the health insurance or evidence of coverage may be identified; is authorized to be viewed or used only for contract bidding purposes; and is confidential for purposes of Chapter 552 (Public Information), Government Code. SECTION 2. Amends Subchapter H, Chapter 26, Insurance Code, by adding Article 26.96, as follows: Art. 26.96. REPORTING OF CLAIMS INFORMATION. (a) Provides that this article applies only to an insured employer health benefit plan. (b) Requires an employer carrier, on written request from an insured 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 employer health benefit plan; _the total amount of payments made by the carrier to health care providers for persons covered under the plan; and _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. (c) Requires an employer carrier to provide information requested by an employer under this article annually not later than the 30th day before the anniversary or renewal date of the employer's health benefit plan. (d) Provides that notwithstanding Subsection (c) of this article, an employer is not required to provide information under Subsection (b) of this article earlier than the 30th day after the date of the initial written request. (e) Prohibits an employer carrier from reporting any information required under this article the release of which is prohibited by federal law or regulation. (f) Requires claim information provided by an employer carrier under this section to be provided in the aggregate, without information through which a specific individual covered by the health insurance or evidence of coverage may be identified. SECTION 3.Makes application of Article 21.49-15, Insurance Code, as added by this Act, prospective. SECTION 4. Makes application of Article 26.96, Insurance Code, as added by this Act, prospective. SECTION 5.Effective date: September 1, 1999. SECTION 6.Emergency clause.