2005 Texas Insurance Code CHAPTER 1209. HEALTH BENEFIT CLAIMS COST INFORMATION REQUIRED TO BE PROVIDED TO EMPLOYER

INSURANCE CODE

CHAPTER 1209. HEALTH BENEFIT CLAIMS COST INFORMATION REQUIRED TO BE 
PROVIDED TO EMPLOYER


	§ 1209.001. APPLICABILITY OF CHAPTER.  This chapter 
applies only to a group health benefit plan, including a small 
employer health benefit plan written under Chapter 1501, that:
		(1)  provides benefits for medical or surgical expenses 
incurred as a result of a health condition, accident, or sickness, 
including a group, blanket, or franchise insurance policy or 
insurance agreement, a group hospital service contract, or a group 
evidence of coverage or similar group coverage document that is 
offered by:
			(A)  an insurance company;                                                   
			(B)  a group hospital service corporation 
operating under Chapter 842;     
			(C)  a fraternal benefit society operating under 
Chapter 885;              
			(D)  a stipulated premium company operating under 
Chapter 884;             
			(E)  a reciprocal exchange operating under 
Chapter 942;                    
			(F)  a health maintenance organization operating 
under Chapter 843;        
			(G)  a multiple employer welfare arrangement that 
holds a certificate of authority under Chapter 846;  or
			(H)  an approved nonprofit health corporation 
that holds a certificate of authority under Chapter 844;  and
		(2)  provides health benefits to the employees of one 
or more employers that sponsor the plan.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1209.002. CLAIMS COST INFORMATION.  (a) On the request 
of an employer sponsoring a group health benefit plan, the plan 
issuer shall provide to the employer the claims cost information 
for employees covered by the plan during the preceding calendar 
year.
	(b)  Claims cost information provided under this section:                      
		(1)  may be provided in the aggregate or on a detailed 
basis;               
		(2)  must be provided separately for each month during 
which the group health benefit plan was in effect;  and
		(3)  may not include information, including diagnosis 
code information, that may be used to identify a specific 
individual enrolled in the plan or a diagnosis of that individual.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1209.003. CONFIDENTIALITY.  Information obtained by an 
employer under this chapter is confidential and may be used by the 
employer only for purposes relating to obtaining or maintaining 
group health benefit plan coverage for the employer's employees.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.