Timely Notification (2005 Texas Senate Bill 51) Frequently Asked….pdfVIP

Timely Notification (2005 Texas Senate Bill 51) Frequently Asked Questions Passage of the 2005 Texas Senate Bill 51 (Group Premium Payment after Employee Termination), by the 79th Texas Legislature Regular Session amended the Texas Insurance Code (TIC). This legislative change applies to all fully insured, managed care benefit plans issued, delivered, or renewed on or after January 1, 2006. Additionally, the legislative change applies to all individuals, employees and dependents covered under fully insured managed care benefit plans. It does not impact self-funded accounts. Under 2005 Senate Bill 51, Group Policyholders (Employers) are responsible for employees’ or insureds’ premium payments from the time the employee or insured ceases to be eligible for coverage, until the end of the contract month in which the Group Policyholder notifies the HMO or insurer that the employee or insured is no longer part of the group and eligible for coverage. Additionally, Group Policyholders are required to provide coverage for the employee or insured under the policy, until the end of the contract month in which the termination notification is received by the benefit plan, carrier or insurer. This legislation also requires insurers and carriers to have appropriate personnel available for benefit description and preauthorization of health care services for dental and vision single service HMO’s. Please Note: These are legislative changes resulting from the passage of 2005 Texas Senate Bill 51 and not business decisions of Blue Cross and Blue Shield of Texas (BCBSTX). Questions and Answers Some of the most commonly asked questions and answers regarding 2005 Texas Senate bill 51 (also referred to herein as Timely Notification Requirements) are listed below to help you better understand the requirements of this legislation. Important Note: All answers related to the process and procedures provided