By Coleman H.B. No. 1173
75R5843 SAW-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage by certain health benefit plans for certain
1-3 serious mental illnesses.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Article 3.51-14, Insurance Code, is amended to
1-6 read as follows:
1-7 Art. 3.51-14. MANDATORY PROVISION OF BENEFITS FOR CERTAIN
1-8 SERIOUS MENTAL ILLNESSES
1-9 Sec. 1. DEFINITIONS [DEFINITION]. For purposes of this
1-10 article:[,]
1-11 (1) "Serious [serious] mental illness" means the
1-12 following psychiatric illnesses as defined by the American
1-13 Psychiatric Association in the Diagnostic and Statistical Manual
1-14 (DSM) [III-R]:
1-15 (A) [(1)] schizophrenia;
1-16 (B) [(2)] paranoid and other psychotic
1-17 disorders;
1-18 (C) [(3)] bipolar disorders (hypomanic, [mixed],
1-19 manic, [and] depressive, and mixed);
1-20 (D) [(4)] major depressive disorders (single
1-21 episode or recurrent); [and]
1-22 (E) [(5)] schizo-affective disorders (bipolar or
1-23 depressive);
1-24 (F) obsessive-compulsive disorders;
2-1 (G) panic disorders;
2-2 (H) pervasive developmental disorders;
2-3 (I) attention deficit disorders;
2-4 (J) tic disorders, including Tourette's
2-5 disorder; and
2-6 (K) depression in childhood and adolescence
2-7 (dysthymia).
2-8 (2) "Health benefit plan" means a plan described by
2-9 Section 2 of this article.
2-10 Sec. 2. SCOPE OF ARTICLE [MANDATORY COVERAGE; EXEMPTION].
2-11 (a) This article applies only to a health benefit plan that
2-12 provides benefits for medical or surgical expenses incurred as a
2-13 result of a health condition, accident, or sickness, including:
2-14 (1) an individual, group, blanket, or franchise
2-15 insurance policy or insurance agreement, a group hospital service
2-16 contract, or an individual or group evidence of coverage that is
2-17 offered by:
2-18 (A) an insurance company;
2-19 (B) a group [Each insurer, nonprofit] hospital
2-20 service [plan] corporation operating under [subject to] Chapter 20
2-21 of this code;
2-22 (C) a[,] health maintenance organization
2-23 operating under [subject to] the Texas Health Maintenance
2-24 Organization Act (Chapter 20A, Vernon's Texas Insurance Code);
2-25 (D) a fraternal benefit society operating under
2-26 Chapter 10 of this code; or
2-27 (E) a stipulated premium insurance company
3-1 operating under Chapter 22 of this code; and
3-2 (2) to the extent permitted by the Employee Retirement
3-3 Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a
3-4 health benefit plan that is offered by:
3-5 (A) a multiple employer welfare arrangement as
3-6 defined by Section 3, Employee Retirement Income Security Act of
3-7 1974 (29 U.S.C. Section 1002); or
3-8 (B) another analogous benefit arrangement [,
3-9 employer, multiple employer, union, association, trustee, or other
3-10 self-funded or self-insured welfare or benefit plan, program, or
3-11 arrangement that issues group health insurance policies, enters
3-12 into health care service contracts or plans, or provides for group
3-13 health benefits, coverage, or services in this state for hospital,
3-14 medical, or surgical expenses incurred as a result of accident or
3-15 sickness shall offer and make available to each group policyholder,
3-16 contract holder, employer, multiple employer, union, association,
3-17 or trustee under a group policy, contract, plan, program, or
3-18 arrangement that provides hospital, surgical, and medical benefits,
3-19 coverage for services and benefits on an expense-incurred, service,
3-20 or prepaid basis for expenses incurred for the necessary care,
3-21 diagnosis, and treatment of serious mental illnesses].
3-22 (b) This article [section] does not apply to coverage under:
3-23 (1) a blanket accident and health insurance policy as
3-24 that term is defined under Section 2, Article 3.51-6 of this code;
3-25 (2) a short-term travel policy;
3-26 (3) an accident-only policy;
3-27 (4) a limited or specified-disease policy; or
4-1 (5) a medicare supplement policy, as that term is
4-2 defined under Section 1(3), Article 3.74 of this code.
4-3 Sec. 3. MENTAL HEALTH [LEVEL OF] COVERAGE. A health benefit
4-4 plan must provide coverage for the medical treatment of serious
4-5 mental illness under the same terms and conditions as coverage is
4-6 provided for other illnesses. The coverage offered under this
4-7 article [for services and benefits for the condition of serious
4-8 mental illness must be at least as favorable as the coverage made
4-9 available for services and benefits provided by the insuring entity
4-10 for other major illnesses and] must include the same durational
4-11 limits, amount limits, deductibles, and coinsurance factors for
4-12 serious mental illness as for other illnesses.
4-13 SECTION 2. This Act takes effect September 1, 1997, and
4-14 applies only to a health benefit plan that is delivered, issued for
4-15 delivery, or renewed on or after January 1, 1998. A health benefit
4-16 plan that is delivered, issued for delivery, or renewed before
4-17 January 1, 1998, is governed by the law as it existed immediately
4-18 before the effective date of this Act, and that law is continued in
4-19 effect for that purpose.
4-20 SECTION 3. The importance of this legislation and the
4-21 crowded condition of the calendars in both houses create an
4-22 emergency and an imperative public necessity that the
4-23 constitutional rule requiring bills to be read on three several
4-24 days in each house be suspended, and this rule is hereby suspended.