88R2143 CJD-F
 
  By: Springer S.B. No. 605
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the definition of state-mandated health benefits for
  the purposes of consumer choice of benefits plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1507.003, Insurance Code, is amended to
  read as follows:
         Sec. 1507.003.  STATE-MANDATED HEALTH BENEFITS. (a) For
  purposes of this subchapter, "state-mandated health benefits"
  means coverage or another feature required under this code or other
  laws of this state to be provided in an individual, blanket, or
  group policy for accident and health insurance or a contract for a
  health-related condition that:
               (1)  includes coverage for specific health care
  services or benefits;
               (2)  places limitations or restrictions on
  deductibles, coinsurance, copayments, or any annual or lifetime
  maximum benefit amounts; [or]
               (3)  includes a specific category of licensed health
  care practitioner from whom an insured is entitled to receive care;
               (4)  requires standard provisions or rights that are
  unrelated to a specific health illness, injury, or condition of an
  insured; or
               (5)  requires the policy or contract to exceed federal
  requirements.
         (b)  For purposes of this subchapter, "state-mandated health
  benefits" does not include benefits that are mandated by federal
  law or standard provisions or rights required under this code or
  other laws of this state to be provided in an individual, blanket,
  or group policy for accident and health insurance if those standard
  provisions or rights are also required to be provided in a basic
  coverage plan under Chapter 1551 [that are unrelated to a specific
  health illness, injury, or condition of an insured, including
  provisions related to:
               [(1)  continuation of coverage under:
                     [(A)  Subchapters F and G, Chapter 1251;
                     [(B)  Section 1201.059; and
                     [(C)  Subchapter B, Chapter 1253;
               [(2)  termination of coverage under Sections 1202.051
  and 1501.108;
               [(3)  preexisting conditions under Subchapter D,
  Chapter 1201, and Sections 1501.102-1501.105;
               [(4)  coverage of children, including newborn or
  adopted children, under:
                     [(A)  Subchapter D, Chapter 1251;
                     [(B)  Sections 1201.053, 1201.061,
  1201.063-1201.065, and Subchapter A, Chapter 1367;
                     [(C)  Chapter 1504;
                     [(D)  Chapter 1503;
                     [(E)  Section 1501.157;
                     [(F)  Section 1501.158; and
                     [(G)  Sections 1501.607-1501.609;
               [(5)  services of practitioners under:
                     [(A)  Subchapters A, B, and C, Chapter 1451; or
                     [(B)  Section 1301.052;
               [(6)  supplies and services associated with the
  treatment of diabetes under Subchapter B, Chapter 1358;
               [(7)  coverage for serious mental illness under
  Subchapter A, Chapter 1355;
               [(8)  coverage for childhood immunizations and hearing
  screening as required by Subchapters B and C, Chapter 1367, other
  than Section 1367.053(c) and Chapter 1353;
               [(9)  coverage for reconstructive surgery for certain
  craniofacial abnormalities of children as required by Subchapter D,
  Chapter 1367;
               [(10)  coverage for the dietary treatment of
  phenylketonuria as required by Chapter 1359;
               [(11)  coverage for referral to a non-network physician
  or provider when medically necessary covered services are not
  available through network physicians or providers, as required by
  Section 1271.055; and
               [(12)  coverage for cancer screenings under:
                     [(A)  Chapter 1356;
                     [(B)  Chapter 1362;
                     [(C)  Chapter 1363; and
                     [(D)  Chapter 1370].
         SECTION 2.  Section 1507.053, Insurance Code, is amended to
  read as follows:
         Sec. 1507.053.  STATE-MANDATED HEALTH BENEFITS. (a) For
  purposes of this subchapter, "state-mandated health benefits"
  means coverage or another feature required under this code or other
  laws of this state to be provided in an evidence of coverage that:
               (1)  includes coverage for specific health care
  services or benefits;
               (2)  places limitations or restrictions on
  deductibles, coinsurance, copayments, or any annual or lifetime
  maximum benefit amounts, including limitations provided in Section
  1271.151; [or]
               (3)  includes a specific category of licensed health
  care practitioner from whom an enrollee is entitled to receive
  care;
               (4)  requires standard provisions or rights that are
  unrelated to a specific health illness, injury, or condition of an
  enrollee; or
               (5)  requires the evidence of coverage to exceed
  federal requirements.
         (b)  For purposes of this subchapter, "state-mandated health
  benefits" does not include coverage that is mandated by federal law
  or standard provisions or rights required under this code or other
  laws of this state to be provided in an evidence of coverage if
  those standard provisions or rights are also required to be
  provided in a basic coverage plan under Chapter 1551 [that are
  unrelated to a specific health illness, injury, or condition of an
  enrollee, including provisions related to:
               [(1)  continuation of coverage under Subchapter G,
  Chapter 1251;
               [(2)  termination of coverage under Sections 1202.051
  and 1501.108;
               [(3)  preexisting conditions under Subchapter D,
  Chapter 1201, and Sections 1501.102-1501.105;
               [(4)  coverage of children, including newborn or
  adopted children, under:
                     [(A)  Chapter 1504;
                     [(B)  Chapter 1503;
                     [(C)  Section 1501.157;
                     [(D)  Section 1501.158; and
                     [(E)  Sections 1501.607-1501.609;
               [(5)  services of providers under Section 843.304;
               [(6)  coverage for serious mental health illness under
  Subchapter A, Chapter 1355; and
               [(7)  coverage for cancer screenings under:
                     [(A)  Chapter 1356;
                     [(B)  Chapter 1362;
                     [(C)  Chapter 1363; and
                     [(D)  Chapter 1370].
         SECTION 3.  The changes in law made by this Act apply only to
  a standard health benefit plan delivered, issued for delivery, or
  renewed under Chapter 1507, Insurance Code, on or after January 1,
  2024. A standard health benefit plan delivered, issued for
  delivery, or renewed under Chapter 1507, Insurance Code, before
  January 1, 2024, is governed by the law as it existed immediately
  before the effective date of this Act, and that law is continued in
  effect for that purpose.
         SECTION 4.  This Act takes effect September 1, 2023.