1-1 AN ACT
1-2 relating to coverage under group health benefit plans for certain
1-3 students.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter C, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.24-2 to read as follows:
1-7 Art. 21.24-2. GROUP COVERAGE OF CERTAIN STUDENTS
1-8 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-9 means a group plan described by Section 2 of this article.
1-10 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to a
1-11 health benefit plan that:
1-12 (1) provides group benefits for medical or surgical
1-13 expenses incurred as a result of a health condition, accident, or
1-14 sickness, including:
1-15 (A) a group, blanket, or franchise insurance
1-16 policy or insurance agreement, a group hospital service contract,
1-17 or a group evidence of coverage that is offered by:
1-18 (i) an insurance company;
1-19 (ii) a group hospital service corporation
1-20 operating under Chapter 20 of this code;
1-21 (iii) a fraternal benefit society
1-22 operating under Chapter 10 of this code;
1-23 (iv) a stipulated premium insurance
1-24 company operating under Chapter 22 of this code; or
2-1 (v) a health maintenance organization
2-2 operating under the Texas Health Maintenance Organization Act
2-3 (Chapter 20A, Vernon's Texas Insurance Code); or
2-4 (B) to the extent permitted by the Employee
2-5 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-6 seq.), a health benefit plan that is offered by:
2-7 (i) a multiple employer welfare
2-8 arrangement as defined by Section 3, Employee Retirement Income
2-9 Security Act of 1974 (29 U.S.C. Section 1002); or
2-10 (ii) another analogous benefit
2-11 arrangement;
2-12 (2) is offered by an approved nonprofit health
2-13 corporation that is certified under Section 5.01(a), Medical
2-14 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
2-15 that holds a certificate of authority issued by the commissioner
2-16 under Article 21.52F of this code; or
2-17 (3) is offered by any other entity not licensed under
2-18 this code or another insurance law of this state that contracts
2-19 directly for health care services on a risk-sharing basis,
2-20 including an entity that contracts for health care services on a
2-21 capitation basis.
2-22 (b) This article does not apply to:
2-23 (1) a plan that provides coverage:
2-24 (A) only for a specified disease;
2-25 (B) only for accidental death or dismemberment;
2-26 (C) for wages or payments in lieu of wages for a
2-27 period during which an employee is absent from work because of
3-1 sickness or injury; or
3-2 (D) as a supplement to liability insurance;
3-3 (2) a plan written under Chapter 26 of this code;
3-4 (3) a Medicare supplemental policy as defined by
3-5 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
3-6 (4) workers' compensation insurance coverage;
3-7 (5) medical payment insurance issued as part of a
3-8 motor vehicle insurance policy; or
3-9 (6) a long-term care policy, including a nursing home
3-10 fixed indemnity policy, unless the commissioner determines that the
3-11 policy provides benefit coverage so comprehensive that the policy
3-12 is a health benefit plan as described by Subsection (a) of this
3-13 section.
3-14 Sec. 3. COVERAGE OF CERTAIN STUDENTS. (a) Each health
3-15 benefit plan that conditions dependent coverage for a child 21
3-16 years of age or older on the child's being a full-time student at
3-17 an educational institution shall provide the coverage for an entire
3-18 academic term during which the child begins as a full-time student
3-19 and remains enrolled, regardless of whether the number of hours of
3-20 instruction for which the child is enrolled is reduced to a level
3-21 that changes the child's academic status to less than that of a
3-22 full-time student. Additionally, the health benefit plan shall
3-23 provide the coverage continuously until the 10th day of instruction
3-24 of the subsequent academic term on which date the health benefit
3-25 plan may terminate coverage of the child if the child does not
3-26 return to full-time student status before that date.
3-27 (b) For purposes of this section, determination of the
4-1 full-time student status of a child subject to this article is made
4-2 in the manner provided by the educational institution at which the
4-3 child is enrolled.
4-4 SECTION 2. Article 21.24-2, Insurance Code, as added by this
4-5 Act, applies only to an insurance policy or evidence of coverage
4-6 that is delivered, issued for delivery, or renewed on or after
4-7 January 1, 1998. A policy or evidence of coverage that is
4-8 delivered, issued for delivery, or renewed before January 1, 1998,
4-9 is governed by the law as it existed immediately before the
4-10 effective date of this Act, and that law is continued in effect for
4-11 this purpose.
4-12 SECTION 3. The importance of this legislation and the
4-13 crowded condition of the calendars in both houses create an
4-14 emergency and an imperative public necessity that the
4-15 constitutional rule requiring bills to be read on three several
4-16 days in each house be suspended, and this rule is hereby suspended.
_______________________________ _______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 864 was passed by the House on May 6,
1997, by a non-record vote.
_______________________________
Chief Clerk of the House
I certify that H.B. No. 864 was passed by the Senate on May
24, 1997, by a viva-voce vote.
_______________________________
Secretary of the Senate
APPROVED: _____________________
Date
_____________________
Governor