By: Haley S.B. No. 458
73R3330 MWV-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health insurance benefits for the treatment of certain
1-3 bones and joints of the human body.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 21.53A, Insurance Code, is amended to
1-6 read as follows:
1-7 Art. 21.53A. Benefits for Certain Bone and Joint Procedures.
1-8 (a) In this article, "health insurance policy" means any
1-9 individual, group, blanket, or franchise insurance policy,
1-10 insurance agreement, or group hospital service contract that
1-11 provides benefits for medical or surgical expenses incurred as a
1-12 result of accident or sickness.
1-13 (b) Each health insurance policy delivered or issued for
1-14 delivery in this state that provides benefits for the medically
1-15 necessary <diagnostic and/or surgical> treatment of skeletal joints
1-16 must include comparable benefits for the medically necessary
1-17 diagnostic, <and/or> surgical, and nonsurgical treatment of the
1-18 temporomandibular (jaw or craniomandibular) joint.
1-19 Temporomandibular joint disorders shall be subject to the same
1-20 conditions, limitations, and precertification of benefits
1-21 provisions as are applicable to treatment of any other joint or
1-22 bone of the body.
1-23 (c) Benefits for temporomandibular joint disorders may be
1-24 subject to reasonable copayment provisions and need not include
2-1 coverage for orthodontic appliances and treatment, crowns, bridges,
2-2 and dentures unless the disorder is trauma related <All other
2-3 policy provisions generally applicable to surgical treatment may
2-4 apply, including any requirements for precertification of
2-5 benefits>.
2-6 (d) <This article does not require a health insurance policy
2-7 to provide dental services if dental services are not otherwise
2-8 scheduled or provided as a part of the policy benefits.>
2-9 <(e)> The provisions of this article shall be applicable to
2-10 a health care plan for basic health care services arranged for or
2-11 provided by a health maintenance organization pursuant to the Texas
2-12 Health Maintenance Organization Act (Chapter 20A, Vernon's Texas
2-13 Insurance Code) and its subsequent amendments <of this code>.
2-14 SECTION 2. This Act takes effect September 1, 1993, and
2-15 applies to a health insurance policy as defined by Article 21.53A,
2-16 Insurance Code, as amended by this Act, and a health care plan
2-17 arranged for or provided by a health maintenance organization under
2-18 the Texas Health Maintenance Organization Act (Chapter 20A,
2-19 Vernon's Texas Insurance Code) and its subsequent amendments
2-20 delivered, issued for delivery, or renewed in this state on or
2-21 after January 1, 1994. A policy or plan delivered, issued for
2-22 delivery, or renewed before January 1, 1994, is governed by the law
2-23 as it existed immediately before the effective date of this Act,
2-24 and that law is continued in effect for that purpose.
2-25 SECTION 3. The importance of this legislation and the
2-26 crowded condition of the calendars in both houses create an
2-27 emergency and an imperative public necessity that the
3-1 constitutional rule requiring bills to be read on three several
3-2 days in each house be suspended, and this rule is hereby suspended.