HBA-ATS C.S.H.B. 2868 76(R)BILL ANALYSIS


Office of House Bill AnalysisC.S.H.B. 2868
By: Capelo
Insurance
4/25/1999
Committee Report (Substituted)


BACKGROUND AND PURPOSE 

Article 26.02 (Definitions), Insurance Code, defines a "large employer" as
an employer who employed an average of at least 51 eligible employees on
business days during the preceding calendar year and who employs at least
two eligible employees on the first day of the plan year.  The statutory
definition does not discriminate between large employers who employ fewer
than 200 people.  Yet, some large employer carriers do.  If a large
employer employs fewer than 200 employees, there is a likelihood that its
carrier may not provide it with information related to the total amount of
claims paid by the carrier for each person covered under the plan.  In
contrast, the carrier may provide the same type of information to an
employer who employs more than 200 people if requested to do so by the
employer.  Denial of such information to large employers who employ fewer
than 200 people may prevent that employer from determining the
competitiveness of the premium it is charged. 

C.S.H.B. 2868 requires a large employer carrier (carrier), if requested by
the employer, to report to the employer information regarding the total
amount of charges submitted to the carrier for persons covered under the
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.  However, a large employer carrier is not obligated to
release such information if its release violates federal law or regulation. 

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 H, Chapter 26, Insurance Code, by adding
Article 26.96, as follows: 

Art. 26.96.  REPORTING OF CLAIMS INFORMATION.  (a) Sets forth that this
article applies only to an insured large employer health benefit plan
(plan).  

(b) Requires a large employer carrier (carrier), on written request from a
large 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 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 a carrier to provide the requested information annually not
later than the 30th day before the anniversary or renewal date of the
employer's plan. 
 
(d) Provides that a large employer is not required to provide information
under this article earlier than the 30th day after the date of the initial
written request. 

(e) Prohibits a carrier from reporting any required information if the
release is prohibited by federal law or regulation. 

SECTION 2.Effective date: September 1, 1999.
Makes application of this Act prospective for an insured large employer
health benefit plan that is delivered,  issued for delivery, or renewed on
or after January 1, 2000. 

SECTION 3.Emergency clause.

COMPARISON OF ORIGINAL TO SUBSTITUTE

C.S.H.B. 2868 modifies the original bill in SECTION 1 by removing from the
information required to be sent to the employer under proposed Article
26.96(b), Insurance Code, the total amount of claims paid by a large
employer carrier for each person covered under an insured large employer
health benefit plan.  Makes a conforming change.