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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage of preexisting conditions |
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and the guaranteed issue of certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. The heading to Chapter 1202, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1202. ISSUANCE, CANCELLATION, AND CONTINUATION OF POLICIES |
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IN GENERAL |
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SECTION 2. The heading to Section 1202.051, Insurance Code, |
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is amended to read as follows: |
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Sec. 1202.051. GUARANTEED ISSUE, RENEWABILITY, AND |
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CONTINUATION OF INDIVIDUAL HEALTH INSURANCE POLICIES. |
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SECTION 3. Section 1202.051, Insurance Code, is amended by |
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adding Subsection (a-1) to read as follows: |
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(a-1) An insurer shall issue the individual health |
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insurance policy chosen by the individual to each individual that |
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elects to be covered under the policy and agrees to satisfy the |
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other requirements of the policy. |
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SECTION 4. Section 1501.602(a), Insurance Code, is amended |
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to read as follows: |
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(a) A large employer health benefit plan issuer: |
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(1) shall issue the large employer health benefit plan |
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chosen by the large employer to each large employer that elects to |
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be covered under the plan and agrees to satisfy the other |
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requirements of the plan [may refuse to provide coverage to a large
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employer in accordance with the issuer's underwriting standards and
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criteria;
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[(2)
shall accept or reject the entire group of
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individuals who meet the participation criteria and choose
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coverage]; and |
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(2) [(3)] may exclude only those employees or |
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dependents who decline coverage. |
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SECTION 5. Subtitle G, Title 8, Insurance Code, is amended |
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by adding Chapter 1509 to read as follows: |
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CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS |
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Sec. 1509.001. DEFINITION. In this chapter, "preexisting |
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condition" means a condition present before the effective date of |
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an individual's coverage under a health benefit plan. |
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Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(8) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(9) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(10) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(11) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(12) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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(13) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(14) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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(c) This chapter applies to coverage under a group health |
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benefit plan provided to a resident of this state regardless of |
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whether the group policy, agreement, or contract is delivered, |
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issued for delivery, or renewed in this state. |
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Sec. 1509.003. EXCEPTIONS. (a) This chapter does not apply |
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to: |
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(1) a plan that provides coverage: |
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(A) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(B) as a supplement to a liability insurance |
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policy; |
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(C) for credit insurance; |
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(D) only for dental or vision care; |
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(E) only for hospital expenses; or |
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(F) only for indemnity for hospital confinement; |
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(2) a workers' compensation insurance policy; or |
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(3) medical payment insurance coverage provided under |
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a motor vehicle insurance policy. |
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(b) This chapter does not apply to an individual health |
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benefit plan issued on or before March 23, 2010, that has not had |
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any significant changes since that date that reduce benefits or |
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increase costs to the individual. |
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Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS |
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PROHIBITED. Notwithstanding any other law, a health benefit plan |
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issuer may not: |
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(1) deny coverage to or refuse to enroll an individual |
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in a health benefit plan on the basis of a preexisting condition; |
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(2) limit or exclude coverage under the health benefit |
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plan for treatment of the individual's preexisting condition |
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otherwise covered under the plan; or |
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(3) charge the individual more for coverage than the |
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health benefit plan issuer charges an individual who does not have a |
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preexisting condition. |
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SECTION 6. Section 1501.605, Insurance Code, is repealed. |
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SECTION 7. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 8. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2020. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2020, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 9. This Act takes effect September 1, 2019. |