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.