Bill Text: TX HB1624 | 2015-2016 | 84th Legislature | Enrolled

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Bill Title: Relating to transparency of certain information related to certain health benefit plan coverage.

Spectrum: Partisan Bill (Republican 2-0)

Status: (Passed) 2015-06-19 - Effective on 9/1/15 [HB1624 Detail]

Download: Texas-2015-HB1624-Enrolled.html

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H.B. No. 1624

AN ACT
relating to transparency of certain information related to certain
health benefit plan coverage.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter B, Chapter 1369, Insurance Code, is
amended by adding Sections 1369.0542, 1369.0543, and 1369.0544 to
read as follows:
Sec. 1369.0542. FORMULARY INFORMATION ON INTERNET WEBSITE.
(a) A health benefit plan issuer shall display on a public Internet
website maintained by the issuer formulary information as required
by the commissioner by rule.
(b) A direct electronic link to the formulary information
must be displayed in a conspicuous manner in the electronic summary
of benefits and coverage of each health benefit plan issued by the
health benefit plan issuer on the health benefit plan issuer's
Internet website. The information must be publicly accessible to
enrollees, prospective enrollees, and others without necessity of
providing a password, a user name, or personally identifiable
information.
Sec. 1369.0543. FORMULARY DISCLOSURE REQUIREMENTS. (a)
The commissioner shall develop and adopt by rule requirements to
promote consistency and clarity in the disclosure of formularies to
facilitate comparison shopping among health benefit plans.
(b) The requirements adopted under Subsection (a) must
apply to each prescription drug:
(1) included in a formulary and dispensed in a network
pharmacy; or
(2) covered under a health benefit plan and typically
administered by a physician or health care provider.
(c) The formulary disclosures must:
(1) be electronically searchable by drug name;
(2) include for each drug the information required by
Subsection (d) in the order listed in that subsection; and
(3) indicate each formulary that applies to each
health benefit plan issued by the issuer.
(d) The formulary disclosures must include for each drug:
(1) the cost-sharing amount for each drug, including
as applicable:
(A) the dollar amount of a copayment; or
(B) for a drug subject to coinsurance:
(i) an enrollee's cost-sharing amount
stated in dollars; or
(ii) a cost-sharing range, denoted as
follows:
(a) under $100 - $;
(b) $100-$250 - $$;
(c) $251-$500 - $$$;
(d) $501-$1,000 - $$$$; or
(e) over $1,000 - $$$$$;
(2) a disclosure of prior authorization, step therapy,
or other protocol requirements for each drug;
(3) if the health benefit plan uses a tier-based
formulary, the specific tier for each drug listed in the formulary;
(4) a description of how prescription drugs will
specifically be included in or excluded from the deductible,
including a description of out-of-pocket costs for a prescription
drug that may not apply to the deductible;
(5) identification of preferred formulary drugs; and
(6) an explanation of coverage of each formulary drug.
(e) The commissioner by rule may allow an alternative method
of making disclosures required under Subsection (d)(1) relating to
cost-sharing through a web-based tool that must:
(1) be publicly accessible to enrollees, prospective
enrollees, and others without necessity of providing a password, a
user name, or personally identifiable information;
(2) allow consumers to electronically search
formulary information by the name under which the health benefit
plan is marketed; and
(3) be accessible through a direct link that is
displayed on each page of the formulary disclosure that lists each
drug as required under Subsection (c).
Sec. 1369.0544. FORMULARY INFORMATION PROVIDED BY TOLL-FREE
TELEPHONE NUMBER. In addition to providing the information
described by Section 1369.0543(d)(1), a health benefit plan issuer
may make the information available to enrollees, prospective
enrollees, and others through a toll-free telephone number that
operates at least during normal business hours.
SECTION 2. Chapter 1451, Insurance Code, is amended by
adding Subchapter K to read as follows:
SUBCHAPTER K. HEALTH CARE PROVIDER DIRECTORIES
Sec. 1451.501. DEFINITIONS. In this subchapter:
(1) "Health care provider" means a practitioner,
institutional provider, or other person or organization that
furnishes health care services and that is licensed or otherwise
authorized to practice in this state. The term includes a
pharmacist, pharmacy, hospital, nursing home, or other medical or
health-related service facility that provides care for the sick or
injured or other care. The term does not include a physician.
(2) "Physician" means an individual licensed to
practice medicine in this state.
Sec. 1451.502. APPLICABILITY OF SUBCHAPTER. This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or a small or large
employer group contract or similar coverage document that is
offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a health maintenance organization operating under
Chapter 843;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
Sec. 1451.503. EXCEPTION. This subchapter does not apply
to:
(1) a health benefit plan that provides coverage:
(A) only for a specified disease or for another
single benefit;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance;
(F) only for dental or vision care;
(G) only for hospital expenses; or
(H) only for indemnity for hospital confinement;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
as amended;
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy;
(5) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan as described
by Section 1451.502;
(6) the child health plan program under Chapter 62,
Health and Safety Code, or the health benefits plan for children
under Chapter 63, Health and Safety Code; or
(7) a Medicaid managed care program operated under
Chapter 533, Government Code, or a Medicaid program operated under
Chapter 32, Human Resources Code.
Sec. 1451.504. PHYSICIAN AND HEALTH CARE PROVIDER
DIRECTORIES. (a) A health benefit plan issuer that offers coverage
for health care services through preferred providers, exclusive
providers, or a network of physicians or health care providers
shall develop and maintain a physician and health care provider
directory in accordance with this subchapter.
(b) The directory must include the name, street address, and
telephone number of each physician and health care provider
described by Subsection (a) and indicate whether the physician or
provider is accepting new patients.
Sec. 1451.505. PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORY
ON INTERNET WEBSITE. (a) A health benefit plan issuer shall display
on a public Internet website maintained by the issuer the directory
required by Section 1451.504. A direct electronic link to the
directory must be displayed in a conspicuous manner in the
electronic summary of benefits and coverage of each health benefit
plan issued by the health benefit plan issuer on the Internet
website.
(b) The health benefit plan issuer shall clearly indicate in
the directory each health benefit plan issued by the issuer that may
provide coverage for services provided by each physician or health
care provider included in the directory.
(c) The directory must be:
(1) electronically searchable by physician or health
care provider name and location; and
(2) publicly accessible without necessity of
providing a password, a user name, or personally identifiable
information.
(d) The health benefit plan issuer shall conduct an ongoing
review of the directory and correct or update the information as
necessary. Except as provided by Subsection (e), corrections and
updates, if any, must be made not less than once each month.
(e) The health benefit plan issuer shall conspicuously
display in the directory required by Section 1451.504 an e-mail
address and a toll-free telephone number to which any individual
may report any inaccuracy in the directory. If the issuer receives a
report from any person that specifically identified directory
information may be inaccurate, the issuer shall investigate the
report and correct the information, as necessary, not later than
the seventh day after the date the report is received.
SECTION 3. The commissioner of insurance shall adopt rules
as required by Section 1369.0543, Insurance Code, as added by this
Act, not later than January 1, 2016.
SECTION 4. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2016. A plan delivered, issued for delivery, or renewed
before January 1, 2016, is governed by the law as it existed
immediately before the effective date of this Act, and that law is
continued in effect for that purpose.
SECTION 5. This Act takes effect September 1, 2015.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1624 was passed by the House on May
15, 2015, by the following vote: Yeas 129, Nays 0, 1 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 1624 on May 29, 2015, by the following vote: Yeas 145, Nays 0,
2 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1624 was passed by the Senate, with
amendments, on May 27, 2015, by the following vote: Yeas 31, Nays
0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor