By Shapiro S.B. No. 147
75R2496 SAW-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to the definition of emergency care for health insurance
1-3 policies and health benefit plans provided by health maintenance
1-4 organizations.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Section 2(I), Chapter 397, Acts of the 54th
1-7 Legislature, 1955 (Article 3.70-2, Vernon's Texas Insurance Code),
1-8 is amended to read as follows:
1-9 (I) An individual or group policy of accident and sickness
1-10 insurance that provides any emergency care benefit, including
1-11 policies issued by companies subject to Chapter 20, Insurance Code,
1-12 delivered or issued for delivery in this state must define
1-13 emergency care as follows: "Emergency care" means health care
1-14 [bona fide emergency] services provided after the recent [sudden]
1-15 onset of a medical condition manifesting itself by acute symptoms
1-16 of sufficient severity, including severe pain, that would lead a
1-17 prudent layperson to reasonably expect [such] that the absence of
1-18 immediate medical attention could [reasonably be expected to]
1-19 result in[:]
1-20 [(1) placing the patient's health in serious jeopardy;]
1-21 [(2)] serious impairment to bodily functions,[; or]
1-22 [(3)] serious dysfunction of any bodily organ or part,
1-23 or placing the patient's health, or if the patient is a pregnant
1-24 woman, the unborn child's health, in serious jeopardy. The term
2-1 includes:
2-2 (1) emergency services provided under Chapter 311,
2-3 Health and Safety Code;
2-4 (2) emergency medical services and care provided under
2-5 Chapter 773, Health and Safety Code; and
2-6 (3) health care services provided to a pregnant woman
2-7 who is having contractions if:
2-8 (A) there is inadequate time to transfer the
2-9 woman to another medical facility safely before delivery; or
2-10 (B) transfer to another medical facility could
2-11 pose a threat to the health or safety of the patient or the unborn
2-12 child.
2-13 SECTION 2. Section 2(t), Texas Health Maintenance
2-14 Organization Act (Article 20A.02, Vernon's Texas Insurance Code),
2-15 is amended to read as follows:
2-16 (t) "Emergency care" means health care [bona fide emergency]
2-17 services provided after the recent [sudden] onset of a medical
2-18 condition manifesting itself by acute symptoms of sufficient
2-19 severity, including severe pain, that would lead a prudent
2-20 layperson to reasonably expect [such] that the absence of immediate
2-21 medical attention could [reasonably be expected to] result in [:]
2-22 [(1) placing the patient's health in serious jeopardy;]
2-23 [(2)] serious impairment to bodily functions,[; or]
2-24 [(3)] serious dysfunction of any bodily organ or part,
2-25 or placing the patient's health, or if the patient is a pregnant
2-26 woman, the unborn child's health, in serious jeopardy. The term
2-27 includes:
3-1 (1) emergency services provided under Chapter 311,
3-2 Health and Safety Code;
3-3 (2) emergency medical services and care provided under
3-4 Chapter 773, Health and Safety Code; and
3-5 (3) health care services provided to a pregnant woman
3-6 who is having contractions if:
3-7 (A) there is inadequate time to transfer the
3-8 woman to another medical facility safely before delivery; or
3-9 (B) transfer to another medical facility could
3-10 pose a threat to the health or safety of the patient or the unborn
3-11 child.
3-12 SECTION 3. Section 2(7), Article 21.58A, Insurance Code, is
3-13 amended to read as follows:
3-14 (7) "Emergency care" means emergency care [bona fide
3-15 emergency services] as defined in Section 2(I), Chapter 397, Acts
3-16 of the 54th Legislature, 1955 (Article 3.70-2, Vernon's Texas
3-17 Insurance Code) and Section 2(t), Texas Health Maintenance
3-18 Organization Act (Article 20A.02, Vernon's Texas Insurance Code).
3-19 SECTION 4. This Act takes effect September 1, 1997, and
3-20 applies only to an insurance policy or evidence of coverage that is
3-21 delivered, issued for delivery, or renewed on or after January 1,
3-22 1998. A policy or evidence of coverage that is delivered, issued
3-23 for delivery, or renewed before January 1, 1998, is governed by the
3-24 law as it existed immediately before the effective date of this
3-25 Act, and that law is continued in effect for that purpose.
3-26 SECTION 5. The importance of this legislation and the
3-27 crowded condition of the calendars in both houses create an
4-1 emergency and an imperative public necessity that the
4-2 constitutional rule requiring bills to be read on three several
4-3 days in each house be suspended, and this rule is hereby suspended.