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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit coverage for hearing aids for children |
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and adults. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1365, Insurance Code, is amended by |
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designating Sections 1365.001 through 1365.004 as Subchapter A and |
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adding a subchapter heading to read as follows: |
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SUBCHAPTER A. GENERAL PROVISIONS |
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SECTION 2. Sections 1365.001 and 1365.002, Insurance Code, |
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are amended to read as follows: |
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Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This |
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subchapter [chapter] applies only to a group health benefit plan |
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that provides hospital and medical coverage on an expense-incurred, |
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service, or prepaid basis, including a group policy, contract, or |
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plan that is offered in this state by: |
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(1) an insurer; |
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(2) a group hospital service corporation operating |
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under Chapter 842; or |
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(3) a health maintenance organization operating under |
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Chapter 843. |
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Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
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LAW. The provisions of Chapter 1201, including provisions relating |
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to the applicability, purpose, and enforcement of that chapter, |
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construction of policies under that chapter, rulemaking under that |
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chapter, and definitions of terms applicable in that chapter, apply |
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to this subchapter [chapter]. |
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SECTION 3. Chapter 1365, Insurance Code, is amended by |
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adding Subchapter B to read as follows: |
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SUBCHAPTER B. HEARING AID COVERAGE |
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Sec. 1365.051. APPLICABILITY. (a) This subchapter applies |
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only to a health benefit plan that provides benefits for medical or |
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surgical expenses incurred as a result of a health condition, |
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accident, or sickness, including an individual, group, blanket, or |
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franchise insurance policy or insurance agreement, a group hospital |
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service contract, or an individual or group evidence of coverage or |
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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) This subchapter applies to coverage under a group health |
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benefit plan described by Subsection (a) provided to a resident of |
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this state, regardless of whether the group policy, agreement, or |
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contract is delivered, issued for delivery, or renewed within or |
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outside this state. |
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(c) Notwithstanding any other law, this subchapter applies |
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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) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; and |
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(9) 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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Sec. 1365.052. EXCEPTION. This subchapter 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; or |
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(B) only for hospital expenses; or |
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(2) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code. |
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Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit |
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plan that provides coverage for hearing aids may not deny an |
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enrollee's claim for a hearing aid solely on the basis that the |
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price of the hearing aid is more than the benefit available under |
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the health benefit plan. |
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(b) Notwithstanding Section 1367.253(d), this section |
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applies to a health benefit plan subject to Subchapter F, Chapter |
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1367. |
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(c) Nothing in this section requires a health benefit plan |
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to pay an enrollee's claim for a hearing aid in an amount that is |
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more than the benefit available under the health benefit plan. |
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SECTION 4. This Act applies only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2024. |
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SECTION 5. This Act takes effect September 1, 2023. |