1-1 By: McCall (Senate Sponsor - Patterson) H.B. No. 864 1-2 (In the Senate - Received from the House May 7, 1997; 1-3 May 8, 1997, read first time and referred to Committee on Economic 1-4 Development; May 17, 1997, reported favorably by the following 1-5 vote: Yeas 7, Nays 0; May 17, 1997, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to coverage under group health benefit plans for certain 1-9 students. 1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-11 SECTION 1. Subchapter C, Chapter 21, Insurance Code, is 1-12 amended by adding Article 21.24-2 to read as follows: 1-13 Art. 21.24-2. GROUP COVERAGE OF CERTAIN STUDENTS 1-14 Sec. 1. DEFINITION. In this article, "health benefit plan" 1-15 means a group plan described by Section 2 of this article. 1-16 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to a 1-17 health benefit plan that: 1-18 (1) provides group benefits for medical or surgical 1-19 expenses incurred as a result of a health condition, accident, or 1-20 sickness, including: 1-21 (A) a group, blanket, or franchise insurance 1-22 policy or insurance agreement, a group hospital service contract, 1-23 or a group evidence of coverage that is offered by: 1-24 (i) an insurance company; 1-25 (ii) a group hospital service corporation 1-26 operating under Chapter 20 of this code; 1-27 (iii) a fraternal benefit society 1-28 operating under Chapter 10 of this code; 1-29 (iv) a stipulated premium insurance 1-30 company operating under Chapter 22 of this code; or 1-31 (v) a health maintenance organization 1-32 operating under the Texas Health Maintenance Organization Act 1-33 (Chapter 20A, Vernon's Texas Insurance Code); or 1-34 (B) to the extent permitted by the Employee 1-35 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 1-36 seq.), a health benefit plan that is offered by: 1-37 (i) a multiple employer welfare 1-38 arrangement as defined by Section 3, Employee Retirement Income 1-39 Security Act of 1974 (29 U.S.C. Section 1002); or 1-40 (ii) another analogous benefit 1-41 arrangement; 1-42 (2) is offered by an approved nonprofit health 1-43 corporation that is certified under Section 5.01(a), Medical 1-44 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 1-45 that holds a certificate of authority issued by the commissioner 1-46 under Article 21.52F of this code; or 1-47 (3) is offered by any other entity not licensed under 1-48 this code or another insurance law of this state that contracts 1-49 directly for health care services on a risk-sharing basis, 1-50 including an entity that contracts for health care services on a 1-51 capitation basis. 1-52 (b) This article does not apply to: 1-53 (1) a plan that provides coverage: 1-54 (A) only for a specified disease; 1-55 (B) only for accidental death or dismemberment; 1-56 (C) for wages or payments in lieu of wages for a 1-57 period during which an employee is absent from work because of 1-58 sickness or injury; or 1-59 (D) as a supplement to liability insurance; 1-60 (2) a plan written under Chapter 26 of this code; 1-61 (3) a Medicare supplemental policy as defined by 1-62 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 1-63 (4) workers' compensation insurance coverage; 1-64 (5) medical payment insurance issued as part of a 2-1 motor vehicle insurance policy; or 2-2 (6) a long-term care policy, including a nursing home 2-3 fixed indemnity policy, unless the commissioner determines that the 2-4 policy provides benefit coverage so comprehensive that the policy 2-5 is a health benefit plan as described by Subsection (a) of this 2-6 section. 2-7 Sec. 3. COVERAGE OF CERTAIN STUDENTS. (a) Each health 2-8 benefit plan that conditions dependent coverage for a child 21 2-9 years of age or older on the child's being a full-time student at 2-10 an educational institution shall provide the coverage for an entire 2-11 academic term during which the child begins as a full-time student 2-12 and remains enrolled, regardless of whether the number of hours of 2-13 instruction for which the child is enrolled is reduced to a level 2-14 that changes the child's academic status to less than that of a 2-15 full-time student. Additionally, the health benefit plan shall 2-16 provide the coverage continuously until the 10th day of instruction 2-17 of the subsequent academic term on which date the health benefit 2-18 plan may terminate coverage of the child if the child does not 2-19 return to full-time student status before that date. 2-20 (b) For purposes of this section, determination of the 2-21 full-time student status of a child subject to this article is made 2-22 in the manner provided by the educational institution at which the 2-23 child is enrolled. 2-24 SECTION 2. Article 21.24-2, Insurance Code, as added by this 2-25 Act, applies only to an insurance policy or evidence of coverage 2-26 that is delivered, issued for delivery, or renewed on or after 2-27 January 1, 1998. A policy or evidence of coverage that is 2-28 delivered, issued for delivery, or renewed before January 1, 1998, 2-29 is governed by the law as it existed immediately before the 2-30 effective date of this Act, and that law is continued in effect for 2-31 this purpose. 2-32 SECTION 3. The importance of this legislation and the 2-33 crowded condition of the calendars in both houses create an 2-34 emergency and an imperative public necessity that the 2-35 constitutional rule requiring bills to be read on three several 2-36 days in each house be suspended, and this rule is hereby suspended. 2-37 * * * * *