By Danburg H.B. No. 2814
75R8930 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to discrimination by certain insurers against individuals
1-3 who use nicotine replacement therapy products.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter B, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.21-9 to read as follows:
1-7 Art. 21.21-9. DISCRIMINATION AGAINST INDIVIDUALS WHO USE
1-8 NICOTINE REPLACEMENT THERAPY PRODUCTS
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Cigarette" has the meaning assigned by Section
1-11 154.001, Tax Code.
1-12 (2) "Health benefit plan" means a plan described by
1-13 Section 2(b) of this article.
1-14 (3) "Nicotine replacement therapy product" means a
1-15 product used by an individual to deliver a controlled dose of
1-16 nicotine to the body for the purpose of reducing the individual's
1-17 dependence on cigarettes or tobacco products. The term does not
1-18 include a cigarette or tobacco product.
1-19 (4) "Tobacco product" has the meaning assigned by
1-20 Section 155.001, Tax Code.
1-21 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to the
1-22 issuer of a life insurance policy or a health benefit plan
1-23 described by Subsection (b).
1-24 (b) This article applies to a health benefit plan that:
2-1 (1) provides benefits for medical or surgical expenses
2-2 incurred as a result of a health condition, accident, or sickness,
2-3 including:
2-4 (A) an individual, group, blanket, or franchise
2-5 insurance policy or insurance agreement, a group hospital service
2-6 contract, or an individual or group evidence of coverage that is
2-7 offered by:
2-8 (i) an insurance company;
2-9 (ii) a group hospital service corporation
2-10 operating under Chapter 20 of this code;
2-11 (iii) a fraternal benefit society
2-12 operating under Chapter 10 of this code;
2-13 (iv) a stipulated premium insurance
2-14 company operating under Chapter 22 of this code; or
2-15 (v) a health maintenance organization
2-16 operating under the Texas Health Maintenance Organization Act
2-17 (Chapter 20A, Vernon's Texas Insurance Code); or
2-18 (B) to the extent permitted by the Employee
2-19 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-20 seq.), a health benefit plan that is offered by:
2-21 (i) a multiple employer welfare
2-22 arrangement as defined by Section 3, Employee Retirement Income
2-23 Security Act of 1974 (29 U.S.C. Section 1002) or another analogous
2-24 benefit arrangement; or
2-25 (ii) any other entity not licensed under
2-26 this code or another insurance law of this state that contracts
2-27 directly for health care services on a risk sharing basis,
3-1 including an entity that contracts for health care services on a
3-2 capitation basis; or
3-3 (2) is offered by an approved nonprofit health
3-4 corporation that is certified under Section 5.01(a), Medical
3-5 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and
3-6 that holds a certificate of authority issued by the commissioner
3-7 under Article 21.52F of this code.
3-8 (c) This article does not apply to:
3-9 (1) a health benefit plan that provides coverage:
3-10 (A) only for a specified disease;
3-11 (B) only for accidental death or dismemberment;
3-12 (C) for wages or payments in lieu of wages for a
3-13 period during which an employee is absent from work because of
3-14 sickness or injury; or
3-15 (D) as a supplement to liability insurance;
3-16 (2) a small employer health benefit plan written under
3-17 Chapter 26 of this code;
3-18 (3) a Medicare supplemental policy as defined by
3-19 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
3-20 (4) workers' compensation insurance coverage;
3-21 (5) medical payment insurance issued as part of a
3-22 motor vehicle insurance policy; or
3-23 (6) a long-term care policy, including a nursing home
3-24 fixed indemnity policy, unless the commissioner determines that the
3-25 policy provides benefit coverage so comprehensive that the policy
3-26 is a health benefit plan as described by Subsection (b) of this
3-27 section.
4-1 Sec. 3. PROHIBITIONS. In writing a life insurance policy or
4-2 health benefit plan, the issuer of the policy or plan, solely
4-3 because an individual is using a nicotine replacement therapy
4-4 product, may not:
4-5 (1) refuse to accept from the individual an
4-6 application for coverage under the life insurance policy or health
4-7 benefit plan;
4-8 (2) refuse to issue, deny, refuse to renew, or cancel
4-9 a life insurance policy or coverage under a health benefit plan;
4-10 (3) limit the amount, extent, or kind of coverage
4-11 available to the individual under the life insurance policy or
4-12 health benefit plan; or
4-13 (4) charge the individual or a group to which the
4-14 individual belongs a higher rate for the same life insurance or
4-15 health benefit plan coverage.
4-16 Sec. 4. SANCTIONS. An issuer of a life insurance policy or
4-17 health benefit plan who violates this article commits unfair
4-18 discrimination under Article 21.21-6 of this code, as added by
4-19 Chapter 415, Acts of the 74th Legislature, Regular Session, 1995,
4-20 and an unfair and deceptive practice under Article 21.21 of this
4-21 code and is subject to the penalties imposed under those articles.
4-22 SECTION 2. This Act takes effect September 1, 1997, and
4-23 applies only to an insurance policy or health benefit plan that is
4-24 delivered, issued for delivery, or renewed on or after January 1,
4-25 1998. A policy or plan that is delivered, issued for delivery, or
4-26 renewed before January 1, 1998, is governed by the law as it
4-27 existed immediately before the effective date of this Act, and that
5-1 law is continued in effect for that purpose.
5-2 SECTION 3. The importance of this legislation and the
5-3 crowded condition of the calendars in both houses create an
5-4 emergency and an imperative public necessity that the
5-5 constitutional rule requiring bills to be read on three several
5-6 days in each house be suspended, and this rule is hereby suspended.