By Hilbert H.B. No. 3310
75R2502 SAW-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to requiring health benefit plans to cover medically
1-3 necessary dental work for children born with cleft palate.
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 21.53A-1 to read as follows:
1-7 Art. 21.53A-1. CERTAIN MEDICALLY NECESSARY DENTAL WORK
1-8 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-9 means a plan described by Section 2 of this article.
1-10 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-11 a health benefit plan that provides benefits for medical or
1-12 surgical expenses incurred as a result of a health condition,
1-13 accident, or sickness, including:
1-14 (1) an individual, group, blanket, or franchise
1-15 insurance policy or insurance agreement, a group hospital service
1-16 contract, or an individual or group evidence of coverage that is
1-17 offered by:
1-18 (A) an insurance company;
1-19 (B) a group hospital service corporation
1-20 operating under Chapter 20 of this code;
1-21 (C) a fraternal benefit society operating under
1-22 Chapter 10 of this code;
1-23 (D) a stipulated premium insurance company
1-24 operating under Chapter 22 of this code; or
2-1 (E) a health maintenance organization operating
2-2 under the Texas Health Maintenance Organization Act (Chapter 20A,
2-3 Vernon's Texas Insurance Code); and
2-4 (2) to the extent permitted by the Employee Retirement
2-5 Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a
2-6 health benefit plan that is offered by:
2-7 (A) a multiple employer welfare arrangement as
2-8 defined by Section 3, Employee Retirement Income Security Act of
2-9 1974 (29 U.S.C. Section 1002); or
2-10 (B) another analogous benefit arrangement.
2-11 (b) This article does not apply to:
2-12 (1) a plan that provides coverage:
2-13 (A) only for a specified disease;
2-14 (B) only for accidental death or dismemberment;
2-15 (C) for wages or payments in lieu of wages for a
2-16 period during which an employee is absent from work because of
2-17 sickness or injury; or
2-18 (D) as a supplement to liability insurance;
2-19 (2) a plan written under Chapter 26 of this code;
2-20 (3) a Medicare supplemental policy as defined by
2-21 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
2-22 (4) workers' compensation insurance coverage;
2-23 (5) medical payment insurance issued as part of a
2-24 motor vehicle insurance policy; or
2-25 (6) a long-term care policy, including a nursing home
2-26 fixed indemnity policy, unless the commissioner determines that the
2-27 policy provides benefit coverage so comprehensive that the policy
3-1 is a health benefit plan as described by Subsection (a) of this
3-2 section.
3-3 Sec. 3. REQUIRED BENEFIT. A health benefit plan must
3-4 provide coverage for all medically necessary dental work for a
3-5 child born with cleft palate. Benefits required under this section
3-6 may not be made subject to a deductible, copayment, or coinsurance
3-7 requirement.
3-8 Sec. 4. RULES. The commissioner may adopt rules to
3-9 implement this article.
3-10 SECTION 2. This Act takes effect September 1, 1997, and
3-11 applies only to a health benefit plan that is delivered, issued for
3-12 delivery, or renewed on or after January 1, 1998. A health benefit
3-13 plan that is delivered, issued for delivery, or renewed before
3-14 January 1, 1998, is governed by the law as it existed immediately
3-15 before the effective date of this Act, and that law is continued in
3-16 effect for that purpose.
3-17 SECTION 3. The importance of this legislation and the
3-18 crowded condition of the calendars in both houses create an
3-19 emergency and an imperative public necessity that the
3-20 constitutional rule requiring bills to be read on three several
3-21 days in each house be suspended, and this rule is hereby suspended.