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.