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.