By Stiles H.B. No. 530
75R2345 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage for childhood immunizations under certain
1-3 health benefit plans.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53F to read as follows:
1-7 Art. 21.53F. COVERAGE FOR CHILDHOOD IMMUNIZATIONS
1-8 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-9 means a plan that provides benefits for medical or surgical
1-10 expenses incurred as a result of a health condition, accident, or
1-11 sickness and that is offered by any insurance company, group
1-12 hospital service corporation, or health maintenance organization
1-13 that delivers or issues for delivery an individual, group, blanket,
1-14 or franchise insurance policy or insurance agreement, a group
1-15 hospital service contract, or an evidence of coverage, or, to the
1-16 extent permitted by the Employee Retirement Income Security Act of
1-17 1974 (29 U.S.C. Section 1001 et seq.), by a multiple employer
1-18 welfare arrangement as defined by Section 3, Employee Retirement
1-19 Income Security Act of 1974 (29 U.S.C. Section 1002), or any other
1-20 analogous benefit arrangement. The term does not include:
1-21 (1) a plan that provides coverage:
1-22 (A) only for a specified disease;
1-23 (B) only for accidental death or dismemberment;
1-24 (C) for wages or payments in lieu of wages for a
2-1 period during which an employee is absent from work because of
2-2 sickness or injury; or
2-3 (D) as a supplement to liability insurance;
2-4 (2) a plan written under Chapter 26 of this code;
2-5 (3) a Medicare supplemental policy as defined by
2-6 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
2-7 (4) workers' compensation insurance coverage;
2-8 (5) medical payment insurance issued as part of a
2-9 motor vehicle insurance policy; or
2-10 (6) a long-term care policy, including a nursing home
2-11 fixed indemnity policy, unless the commissioner determines that the
2-12 policy provides benefit coverage so comprehensive that the policy
2-13 meets the definition of a health benefit plan.
2-14 Sec. 2. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. A
2-15 health benefit plan that provides benefits for a family member of
2-16 the insured shall provide coverage for each child of the insured,
2-17 from birth through the date the child is six years of age, for:
2-18 (1) immunization against:
2-19 (A) diphtheria;
2-20 (B) haemophilus influenzae type b;
2-21 (C) hepatitis B;
2-22 (D) measles;
2-23 (E) mumps;
2-24 (F) pertussis;
2-25 (G) polio;
2-26 (H) rubella;
2-27 (I) tetanus; and
3-1 (J) varicella; and
3-2 (2) any other immunization that the commissioner
3-3 determines to be required by law for the child.
3-4 Sec. 3. FIRST-DOLLAR COVERAGE REQUIRED. Benefits required
3-5 under Section 2 of this article may not be made subject to a
3-6 deductible, copayment, or coinsurance requirement.
3-7 SECTION 2. This Act takes effect September 1, 1997, and
3-8 applies only to a health benefit plan that is delivered, issued for
3-9 delivery, or renewed on or after January 1, 1998. A health
3-10 benefit plan that is delivered, issued for delivery, or renewed
3-11 before January 1, 1998, is governed by the law as it existed
3-12 immediately before the effective date of this Act, and that law is
3-13 continued in effect for this purpose.
3-14 SECTION 3. The importance of this legislation and the
3-15 crowded condition of the calendars in both houses create an
3-16 emergency and an imperative public necessity that the
3-17 constitutional rule requiring bills to be read on three several
3-18 days in each house be suspended, and this rule is hereby suspended.