SRC-JFA C.S.S.B. 172 75(R)BILL ANALYSIS


Senate Research CenterC.S.S.B. 172
By: Zaffirini
Health & Human Services
3-4-97
Committee Report (Substituted)


DIGEST 

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, C.S.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

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

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.  Provides that a long-term care policy is not within the
scope of this article unless the commissioner of the Texas Department of
Insurance (commissioner) determines that such a policy provides benefit
coverage so comprehensive that the policy is a health benefit plans as
described by Subsection (a) of this section.   

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 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.

SUMMARY OF COMMITTEE CHANGES

Amends SECTION 1, Section 2, Article 21.53F Insurance Code, to provide
that this article applies to, among others, certain health benefit plans
offered by a multiple employer welfare arrangement subject to regulation
under Chapter 3I, Insurance Code.  Deletes proposed provisions providing
that this article applies to certain health benefit plans offered by a
multiple employer welfare arrangement as defined by Section 3, Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1002), or those
plans offered by any other entity not licensed under this code or another
insurance law of this state that contracts directly for health care
services on a risk sharing basis, including an entity that contracts for
health care services on a capitation basis.  Amends proposed provisions in
Subsection (b), to provide that this article does not apply to a small
employer health benefit plan written under Chapter 26, Insurance Code, or
a plan that provides coverage for limited benefits, credited insurance,
limited to dental care or care of vision, or hospital confinement
indemnity coverage. Make nonsubstantive changes.     

Amends SECTION 1, Section 3, Article 21.53F, Insurance Code, to revise
proposed provisions in which children are entitled to benefits under this
section.  

Amends SECTION 1, Section 4, Article 21.53F, Insurance Code, to revise
proposed provisions in regard to the prohibition of a deductible,
copayment, or coinsurance requirement.