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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 to health insurance 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 premiums 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 Health Maintenance Organization (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 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. CST 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. CST 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.

Blue Cross and Blue Shield of Texas/HMO Blue® Texas are committed to providing access to quality, affordable health care coverage. Thank you for choosing Blue Cross and Blue Shield of Texas/HMO Blue Texas for your health care coverage needs.

The new health care law has opened a new door for the group of losers known as SCAMMERS OR FRAUDERS”.  These scammers are selling bogus policies through 1-800 numbers and even going door to door.

Kathleen Sebelius, secretary of the US Department of Health and Human Services-as well as former insurance commissioner from Kansas–sent letters to state insurance regulators and prosecutors about the new schemes. (National Underwriter vol.114 no. 13)

Beware of any person coming to your door, email, fraudulent online ads, or pushy telemarketer that is selling a limited benefit health insurance policy that you are required to purchase under the new health care law. 

At Texas Health and Life we try to stay very informed and keep our customers and friends informed on the true changes to health insurance with the new health care law.  To set the record straight for this blog–the new health care law does not require you in any way to change your current health insurance.  The most recent change to health insurance because of the health care reform law are related to making health insurance companies change how they cover children with pre-existing conditions.

For up to date changes in the health care reform become a fan of our Facebook page or read our blog regularly.  If you would like personal assistance please call one of our health insurance professionals at Texas Health and Life at 1-800-371-2015.

Take care and Be well!

Are you a small business that offers health insurance?  Did you know that with healthcare reform and the recently enacted Patient Protection and Affordable Care Act may allow your business to receive a tax credit if you offer health insurance to your employees. 

According to a recent postcard our office received from the IRS Notice 1397–If your small business or tax exempt organization pays employee health insurance premiums in 2010, you may be may be eligible to claim a new credit on your 2010 tax return.  Employers with fewer than 25 employees (more if you have part-time employees) and less than $50,000 in average wages may be eligible.

Eligible small employers could qualify for a credit worth up to 35% of premiums paid in 2010 (for businesses) or 25% of premiums paid(for tax-exempt groups).

Find out if you are eligible by visiting www.irs.gov or consult your tax professional to learn more about whether your small business qualifies for this valuable incentive to provide health coverage for your employees.

Take care and be well!

For more information about affordable group health insurance options for your business contact Texas Health and Life at 1-800-371-2015