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Senate Bill 51 Requirements and
Impacts to Employer Groups

The 79th Texas Legislature, Regular Session, recently passed and signed into law, Senate Bill 51. This notice is provided to make you aware of highlighted requirements and impacts to employer groups.

• Senate Bill 51 amends Chapter 843 and Chapter 1301
of the Texas Insurance Code and applies tohealth benefit plans issued, delivered or renewed on or after January 1, 2006. The legislation applies to all individuals (employees and dependents) covered under fully insured business, but does not impact self-funded accounts.

Key aspects of Senate Bill 51 include:

Premium payment and coverage after enrollee’s / insured’s termination

• Group policyholders are liable for an enrollee’s or individual insured’s premium payments from the time the person ceases to be eligible for coverage until the end of the month, in which the group policyholder notifies the HMO or insurer, that the person is no longer part of the group and eligible for coverage; and

• Group policyholders are required to provide coverage for the enrollee or individual insured, under the policy, until the end of the notification month.

• For example, when an employee terms on 08/20/05 and the employer notifies the carrier on 09/06/05, the employer is responsible for paying premium for the entire month of September.


Dental and vision single service HMO’s verification

• Senate Bill 51 requires that appropriate personnel must be available for verification and preauthorization of health care services for dental and vision single service HMOs between 8 a.m. and 5 p.m. (CT) Monday through Friday for each day that is not a holiday; and

• Single service HMOs must have a telephone system capable of accepting or recording incoming phone calls for verification after 5 p.m. Monday through Friday and all day Saturday, Sunday and legal holidays. Responses are required to calls accepted or recorded, not later than the next business day after the date the call is received.

The information provided in this notice and other communications regarding legislative impacts is designed to keep you informed about the status of these efforts. Such information contained in this notice reflects our understanding and expectations at the time it is provided.
Additional information will be forthcoming as implementation procedures are finalized.