S.B. No. 1403

	AN ACT
	relating to changing the Texas Health Insurance Risk Pool to the
	Texas Health Insurance Pool, and to the operation of that pool.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  The heading to Chapter 1506, Insurance Code, is
	amended to read as follows:
	CHAPTER 1506. TEXAS HEALTH INSURANCE [RISK] POOL
	SECTION 2.  Subdivision (7), Section 1506.001, Insurance
	Code, is amended to read as follows:
	(7)  "Pool" means the Texas Health Insurance [Risk]
	Pool.
	SECTION 3.  Subchapter A, Chapter 1506, Insurance Code, is
	amended by adding Section 1506.010 to read as follows:
	Sec. 1506.010.  REDESIGNATION.  Effective September 1, 2009,
	the Texas Health Insurance Risk Pool is redesignated the Texas
	Health Insurance Pool. A reference in any law to the Texas Health
	Insurance Risk Pool means the Texas Health Insurance Pool.
	SECTION 4.  Section 1506.152, Insurance Code, is amended by
	amending Subsections (b) and (c) and adding Subsection (f) to read
	as follows:
	(b)  Subject to Subsection (f), each [Each] dependent of an
	individual who is eligible for coverage from the pool is also
	eligible for coverage from the pool.
	(c)  Subject to Subsection (f), if [If] an individual who
	obtains coverage from the pool under Subsection (a) is a child, each
	parent, grandparent, brother, sister, or child of that individual
	who resides with that individual is also eligible for coverage from
	the pool.
	(f)  A dependent or individual described by Subsection (c)
	who is not a federally defined eligible individual and who has not
	experienced a significant break in coverage may not obtain coverage
	from the pool before the first date on which the dependent or
	individual has been:
	(1)  a legally domiciled resident of this state for at
	least the 30 days preceding the date of the application for coverage
	from the pool; and
	(2)  a citizen or permanent resident of the United
	States for at least three continuous years.
	SECTION 5.  Section 1506.153, Insurance Code, as amended by
	Chapters 808 (S.B. 1254), 881 (H.B. 1977), and 1070 (H.B. 2548),
	Acts of the 80th Legislature, Regular Session, 2007, is reenacted
	and amended to read as follows:
	Sec. 1506.153.  INELIGIBILITY FOR COVERAGE. (a)  Notwithstanding
	Section 1506.152 [Section 1506.152(a)-(c)], an individual is not
	eligible for coverage from the pool if:
	(1)  on the date pool coverage is to take effect, the
	individual has health benefit plan coverage from a health benefit
	plan issuer or health benefit arrangement in effect, except as
	provided by Section 1506.152(a)(3)(E);
	(2)  at the time the individual applies to the pool,
	except as provided in Subsection (b), the individual is eligible
	for other health care benefits, including an offer of benefits from
	the continuation of coverage under Title X, Consolidated Omnibus
	Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et
	seq.)[, as amended] (COBRA), other than:
	(A)  coverage, including COBRA or other
	continuation coverage or conversion coverage, maintained for any
	preexisting condition waiting period under a pool policy or during
	any preexisting condition waiting period or other waiting period of
	the other coverage;
	(B)  employer group coverage conditioned by a
	limitation of the kind described by Section 1506.152(a)(3)(A) or
	(C); or
	(C)  individual coverage conditioned by a
	limitation described by Section 1506.152(a)(3)(C) or (D);
	(3)  within 12 months before the date the individual
	applies to the pool, the individual terminated coverage in the
	pool, unless the individual:
	(A)  demonstrates a good faith reason for the
	termination; or
	(B)  is a federally defined eligible individual;
	(4)  the individual is confined in a county jail or
	imprisoned in a state or federal prison;
	(5)  any of the individual's premiums are paid for or
	reimbursed under a government-sponsored program or by a government
	agency or health care provider;
	(6)  the individual's prior coverage with the pool was
	terminated:
	(A)  during the 12-month period preceding the date
	of application for nonpayment of premiums; or
	(B)  for fraud; or
	(7)  the individual is eligible for health benefit plan
	coverage provided in connection with a policy, plan, or program
	paid for or sponsored by an employer, even though the employer
	coverage is declined. This subdivision does not apply to an
	individual who is a part-time employee or a part-time employee's
	dependent eligible to participate in an employer plan that provides
	health benefit coverage:
	(A)  that is more limited or restricted than
	coverage with the pool; and
	(B)  for which there is no employer contribution
	to the premium, either directly or indirectly.
	(b)  An individual eligible for benefits from the
	continuation of coverage under Title X, Consolidated Omnibus Budget
	Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.)[, as
	amended] (COBRA), or a comparable federal or state employee
	coverage continuation program, who did not elect continuation of
	coverage during the election period, or whose elected continuation
	of coverage lapsed or was cancelled without reinstatement, is
	eligible for pool coverage. Eligibility under this subsection is
	subject to a minimum 180-day exclusion of coverage under Section
	1506.155(a-1).
	SECTION 6.  Section 1506.155, Insurance Code, is amended by
	amending Subsection (a-1) and adding Subsection (c-1) to read as
	follows:
	(a-1)  Except as provided by Section 1506.056, pool coverage
	for an individual eligible pursuant to Section 1506.153(b) excludes
	charges or expenses incurred before the first anniversary of [the
	expiration of 180 days from] the effective date of coverage with
	regard to any condition for which:
	(1)  the existence of symptoms would cause an
	ordinarily prudent person to seek diagnosis, care, or treatment
	within the six-month period preceding the effective date of
	coverage; or
	(2)  medical advice, care, or treatment was recommended
	or received during the six-month period preceding the effective
	date of coverage.
	(c-1)  If an individual eligible under Section 1506.153(b)
	was covered by creditable coverage at any time during the 12-month
	period immediately preceding the effective date of the individual's
	coverage under the pool, the pool shall subtract from the exclusion
	period required under Subsection (a-1) up to 180 days of:
	(1)   the period during which the individual was
	covered under the creditable coverage; and
	(2)  any waiting period that applied before the
	creditable coverage became effective.
	SECTION 7.  Subsection (b), Section 1506.2523, Insurance
	Code, is amended to read as follows:
	(b)  For purposes of this section, gross health benefit plan
	premiums do not include premiums collected for:
	(1)  coverage under a Medicare supplement benefit plan
	subject to Chapter 1652;
	(2)  coverage under a small employer health benefit
	plan subject to Subchapters A-H, Chapter 1501; or
	(3)  coverage or insurance listed in Section
	1506.002(b), (c), or (d).
	SECTION 8.  This Act applies only to an application for
	initial or renewal coverage through the Texas Health Insurance Risk
	Pool under Chapter 1506, Insurance Code, as amended by this Act,
	that is filed with the pool on or after January 1, 2010. An
	application filed before that date is governed by the law in effect
	on the date on which the application was filed, and the former law
	is continued in effect for that purpose.
	SECTION 9.  This Act takes effect September 1, 2009.
	______________________________	______________________________
	President of the Senate	Speaker of the House
	I hereby certify that S.B. No. 1403 passed the Senate on
	April 9, 2009, by the following vote:  Yeas 31, Nays 0.
	______________________________
	Secretary of the Senate
	I hereby certify that S.B. No. 1403 passed the House on
	May 26, 2009, by the following vote:  Yeas 144, Nays 0, one
	present not voting.
	______________________________
	Chief Clerk of the House
	Approved:
	______________________________
	Date
	______________________________
	Governor