bill orders one standard coordination of benefits form

The text as introduced · 537 words

89R724 MEW-D

By: Hughes
S.B. No. 684

A BILL TO BE ENTITLED

AN ACT

relating to a uniform coordination of benefits questionnaire for

health benefit plans.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Chapter 1203, Insurance Code, is amended by

adding Subchapter D to read as follows:

SUBCHAPTER D. COORDINATION OF BENEFITS QUESTIONNAIRE

Sec. 1203.151. APPLICABILITY OF SUBCHAPTER. (a) 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 an individual or

group evidence of coverage or similar coverage document that is

issued by:

(1) an insurance company;

(2) a group hospital service corporation operating

under Chapter 842;

(3) a health maintenance organization operating under

Chapter 843;

(4) an approved nonprofit health corporation that

holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds

a certificate of authority under Chapter 846;

(6) a stipulated premium company operating under

Chapter 884;

(7) a Lloyd's plan operating under Chapter 941; or

(8) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this subchapter applies

to:

(1) a small employer health benefit plan subject to

Chapter 1501, including coverage provided through a health group

cooperative under Subchapter B of that chapter;

(2) a standard health benefit plan issued under

Chapter 1507;

(3) a basic coverage plan under Chapter 1551;

(4) a basic plan under Chapter 1575;

(5) a primary care coverage plan under Chapter 1579;

(6) a plan providing basic coverage under Chapter

1601;

(7) alternative health benefit coverage offered by a

subsidiary of the Texas Mutual Insurance Company under Subchapter

M, Chapter 2054;

(8) group health coverage made available by a school

district in accordance with Section 22.004, Education Code;

(9) the state Medicaid program, including the Medicaid

managed care program operated under Chapter 540, Government Code;

(10) the child health plan program under Chapter 62,

Health and Safety Code;

(11) a regional or local health care program operated

under Section 75.104, Health and Safety Code; and

(12) a self-funded health benefit plan sponsored by a

professional employer organization under Chapter 91, Labor Code.

Sec. 1203.152. CREATION OF UNIFORM COORDINATION OF BENEFITS

QUESTIONNAIRE. In collaboration with appropriate stakeholders,

the commissioner shall adopt rules establishing a uniform

coordination of benefits questionnaire to be used by all health

benefit plan issuers in this state.

Sec. 1203.153. UNIFORM COORDINATION OF BENEFITS

QUESTIONNAIRE REQUIRED. Each health benefit plan issuer that

issues a health benefit plan that includes a coordination of

benefits provision shall use the uniform coordination of benefits

questionnaire established under Section 1203.152 and make the

questionnaire available to health care providers as appropriate.

SECTION 2. (a) Not later than January 1, 2026, the

commissioner of insurance shall adopt rules establishing the

uniform coordination of benefits questionnaire under Section

1203.152, Insurance Code, as added by this Act.

(b) The changes in law made by this Act apply only to the use

of a coordination of benefits questionnaire on or after February 1,

2026.

SECTION 3. This Act takes effect September 1, 2025.