Bill Text: TX HB1253 | 2011-2012 | 82nd Legislature | Engrossed

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Bill Title: Relating to certain modifications of a health benefit plan.

Spectrum: Slight Partisan Bill (Republican 3-1)

Status: (Engrossed - Dead) 2011-05-05 - Referred to State Affairs [HB1253 Detail]

Download: Texas-2011-HB1253-Engrossed.html

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82R20189 RWG-F
By: Smithee, Hardcastle, Eiland, Nash H.B. No. 1253

A BILL TO BE ENTITLED
AN ACT
relating to certain modifications of a health benefit plan.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is
amended by adding Section 1369.0541 to read as follows:
Sec. 1369.0541. MODIFICATION OF DRUG COVERAGE UNDER PLAN.
(a) In addition to applying to a group health benefit plan to which
this subchapter applies, this section applies to an individual
health benefit plan, as defined by Section 544.501.
(b) Notwithstanding Section 1369.053, this section applies
to a small employer health benefit plan written under Chapter 1501.
(c) A group or individual health benefit plan issuer may
modify drug coverage provided under a health benefit plan if:
(1) the modification occurs at the time of coverage
renewal;
(2) the modification is effective uniformly among all
group health benefit plan sponsors covered by identical or
substantially identical health benefit plans or all individuals
covered by identical or substantially identical individual health
benefit plans, as applicable; and
(3) not later than the 60th day before the date the
modification is effective, the issuer provides written notice of
the modification to the commissioner, each affected group health
benefit plan sponsor, each affected enrollee in an affected group
health benefit plan, and each affected individual health benefit
plan holder.
(d) Modifications affecting drug coverage that require
notice under Subsection (c) include:
(1) removing a drug from a formulary;
(2) adding a requirement that an enrollee receive
prior authorization for a drug;
(3) imposing or altering a quantity limit for a drug;
(4) imposing a step-therapy restriction for a drug;
and
(5) moving a drug to a higher cost-sharing tier unless
a generic drug alternative to the drug is available.
(e) A group or individual health benefit plan issuer may
elect to offer an enrollee in the plan the option of receiving
notifications required by this section by e-mail.
SECTION 2. Section 1501.108(d), Insurance Code, is amended
to read as follows:
(d) Notwithstanding Subsection (a), a small or large
employer health benefit plan issuer may modify a small or large
employer health benefit plan in accordance with Section 1369.0541
or if:
(1) the modification occurs at the time of coverage
renewal;
(2) the modification is effective uniformly among all
small or large employers covered by that health benefit plan; and
(3) the issuer notifies the commissioner and each
affected covered small or large employer of the modification not
later than the 60th day before the date the modification is
effective.
SECTION 3. This Act takes effect September 1, 2011.