SRC-HRD S.B. 53 75(R)    BILL ANALYSIS


Senate Research CenterS.B. 53
By: Shapiro
Economic Development
3-3-97
As Filed


DIGEST 

Currently, Texas law does not require a health maintenance organization
(HMO) or health insurance plan to provide full coverage to an adopted
child without limiting coverage of a preexisting condition.  This bill
would require an HMO or health insurance plan to provide full coverage
without regard to preexisting conditions.  S.B. 53 would also prohibit an
HMO or health insurance plan from excluding or limiting coverage of a
newborn child or placing limitations or exclusions for congenital defects
of a newborn child.  In addition, in making the above changes, this bill
amends current law to correspond to the federal Kassebaum/Kennedy
legislation. 

PURPOSE

As proposed, S.B. 53, prohibits a health insurer or Health Maintenance
Organization (HMO), under certain conditions, from denying or limiting
coverage to an adopted child, or to a newborn.  Prohibits a health insurer
or HMO, under certain conditions, from limiting coverage of a preexisting
condition of an adopted child.  

RULEMAKING AUTHORITY

This bill does not grant any additional rulemaking authority to a state
officer, institution, or agency. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Section 3D(b), Article 3.51-6, Insurance Code, to
require an insurer that provides a health insurance policy to a person
that includes coverage for the immediate family or children of the person
insured, to provide full coverage under the policy to the adopted child
without limiting coverage of a preexisting condition if an application for
coverage for the child is made not later than 31st day after the date on
which the adoption is final. 

SECTION 2.  Amends Chapter 20A, V.T.C.S. (The Texas Health Maintenance
Organization Act), V.T.C.S. by adding Section 9A, as follows: 

Sec. 9A.  REQUIRED COVERAGE FOR NEWBORNS; ADOPTED CHILDREN. Requires each
health maintenance organization (HMO) that provides coverage for health
care services for the dependents of an enrollee to include full coverage
for the newborn child of an enrollee if the child is enrolled in the
health care plan not later than the 31st day after the date of the child's
birth.  Prohibits an HMO that provides coverage for the immediate family
or children of an enrollee from excluding from coverage or limiting
coverage to a child of an enrollee solely because the child is adopted.
Requires the HMO to provide full coverage under the plan to the child
without limiting coverage of a preexisting condition if the child is
enrolled in the plan not later than the 31st day after the date on which
the adoption is final.  
SECTION 3.  Makes Section 3D(b), Article 3.51-6, Insurance Code, as
amended by Section 1 of this Act, prospective to January 1, 1998.  

SECTION 4.  Makes Section 9A, Chapter 20A, V.T.C.S., as added by Section 2
of this Act, prospective to January 1, 1998.  

SECTION 5.  Effective date:  September 1, 1997.
 
SECTION 6.  Emergency clause.