RS S.B. 172 75(R) BILL ANALYSIS INSURANCE S.B. 172 By: Zaffirini (Stiles) 4-18-97 Committee Report (Unamended) BACKGROUND Currently, Texas law requires immunizations of children by the time they enter school, which is generally when they are six years old. The Insurance Code does not require health benefit plans to pay for immunizations of children of those insured. This bill would require certain health benefit plans to pay for certain immunizations of children between the years of 0 to 6 of those insured by the plans. PURPOSE As proposed, S.B. 172 requires certain health care plans to provide childhood immunizations for certain diseases without requiring the insured to pay a deductible, copayment, or coinsurance requirement. RULEMAKING AUTHORITY It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, institution, or authority. SECTION BY SECTION ANALYSIS SECTION 1. Amends Chapter 21E, Insurance Code, by adding Article 21.53F, as follows: Art. 21.53F. COVERAGE FOR CHILDHOOD IMMUNIZATIONS Sec. 1. DEFINITION. Defines "health benefit plan." Sec. 2. SCOPE OF ARTICLE. Sets forth the health benefit plans that are within the scope of this article and those that are not within the scope of this article. Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. Requires a health benefit plan that provides benefits for a family member of the insured to provide immunization for each covered child described in this section, from birth through the date the child is six years of age, for diphtheria, haemophilus influenzae type b; hepatitis B; measles; mumps; pertussis; polio; rubella; tetanus; varicella; and any other immunization that is required by law for the child. Provides that a child is entitled to benefits under this section if the child, as a result of the child's relationship to an enrollee in the health benefit plan, would be entitled to benefits under an accident and sickness insurance policy under Subsection (K), (L), or (M), Article 3.70-2, Insurance Code. Sec. 4. FIRST DOLLAR COVERAGE REQUIRED. Prohibits the benefits required under Section 3 from being made subject to a deductible, copayment, or coinsurance requirement. Provides that Subsection (a) of this section does not prohibit the application of a deductible, copayment, or coinsurance requirement to another service provided at the same time as the immunization. SECTION 2. Effective date: September 1, 1997. Makes application of this Act prospective to January 1, 1998. SECTION 3. Emergency clause.