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.