AN ACT

 1-1     relating to coverage for childhood immunizations under certain

 1-2     health benefit plans.

 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-4           SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is

 1-5     amended by adding Article 21.53F to read as follows:

 1-6           Art. 21.53F.  COVERAGE FOR CHILDHOOD IMMUNIZATIONS

 1-7           Sec. 1.  DEFINITION.  In this article, "health benefit plan"

 1-8     means a plan described by Section 2 of this article.

 1-9           Sec. 2.  SCOPE OF ARTICLE.  (a)  This article applies only to

1-10     a health benefit plan that:

1-11                 (1)  provides benefits for medical or surgical expenses

1-12     incurred as a result of a health condition, accident, or sickness,

1-13     including an individual, group, blanket, or franchise insurance

1-14     policy or insurance agreement, a group hospital service contract,

1-15     or an individual or group evidence of coverage that is offered by:

1-16                       (A)  an insurance company;

1-17                       (B)  a group hospital service corporation

1-18     operating under Chapter 20 of this code;

1-19                       (C)  a fraternal benefit society operating under

1-20     Chapter 10 of this code;

1-21                       (D)  a stipulated premium insurance company

1-22     operating under Chapter 22 of this code;

1-23                       (E)  a health maintenance organization operating

 2-1     under the Texas Health Maintenance Organization Act (Chapter 20A,

 2-2     Vernon's Texas Insurance Code); or

 2-3                       (F)  a multiple employer welfare arrangement

 2-4     subject to regulation under Subchapter I, Chapter 3 of this code;

 2-5     or

 2-6                 (2)  is offered by an approved nonprofit health

 2-7     corporation that is certified under Section 5.01(a), Medical

 2-8     Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and

 2-9     that holds a certificate of authority issued by the commissioner

2-10     under Article 21.52F of this code.

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 or other

2-14     limited benefit;

2-15                       (B)  only for accidental death or dismemberment;

2-16                       (C)  for wages or payments in lieu of wages for a

2-17     period during which an employee is absent from work because of

2-18     sickness or injury;

2-19                       (D)  as a supplement to liability insurance;

2-20                       (E)  for credit insurance;

2-21                       (F)  only for dental or vision care; or

2-22                       (G)  only for indemnity for hospital confinement;

2-23                 (2)  a small employer health benefit plan written under

2-24     Chapter 26 of this code;

2-25                 (3)  a Medicare supplemental policy as defined by

 3-1     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);

 3-2                 (4)  workers' compensation insurance coverage;

 3-3                 (5)  medical payment insurance issued as part of a

 3-4     motor vehicle insurance policy; or

 3-5                 (6)  a long-term care policy, including a nursing home

 3-6     fixed indemnity policy, unless the commissioner determines that the

 3-7     policy provides benefit coverage so comprehensive that the policy

 3-8     is a health benefit plan as described by Subsection (a) of this

 3-9     section.

3-10           (c)  Notwithstanding Section 172.014, Local Government Code,

3-11     or any other law, this article applies to health and accident

3-12     coverage provided by a risk pool created under Chapter 172, Local

3-13     Government Code.

3-14           Sec. 3.  REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS.

3-15     (a)  A health benefit plan that provides benefits for a family

3-16     member of the insured shall provide coverage for each covered child

3-17     described by Subsection (b) of this section, from birth through the

3-18     date the child is six years of age, for:

3-19                 (1)  immunization against:

3-20                       (A)  diphtheria;

3-21                       (B)  haemophilus influenzae type b;

3-22                       (C)  hepatitis B;

3-23                       (D)  measles;

3-24                       (E)  mumps;

3-25                       (F)  pertussis;

 4-1                       (G)  polio;

 4-2                       (H)  rubella;

 4-3                       (I)  tetanus; and

 4-4                       (J)  varicella; and

 4-5                 (2)  any other immunization that is required by law for

 4-6     the child.

 4-7           (b)  A child is entitled to benefits under this section if

 4-8     the child, as a result of the child's relationship to an enrollee

 4-9     in the health benefit plan, would be entitled to benefits under an

4-10     accident and sickness insurance policy under Subsection (K), (L),

4-11     or (M), Section 2, Chapter 397, Acts of the 54th Legislature, 1955

4-12     (Article 3.70-2, Vernon's Texas Insurance Code).

4-13           Sec. 4.  FIRST DOLLAR COVERAGE REQUIRED.  (a)  Benefits

4-14     required under Section 3 of this article may not be made subject to

4-15     a deductible, copayment, or coinsurance requirement.

4-16           (b)  Subsection (a) of this section does not prohibit the

4-17     application of a deductible, copayment, or coinsurance requirement

4-18     to another service provided at the same time as the immunization.

4-19           SECTION 2.  This Act takes effect September 1, 1997, and

4-20     applies only to a health benefit plan that is delivered, issued for

4-21     delivery, or renewed on or after January 1, 1998.  A health benefit

4-22     plan that is delivered, issued for delivery, or renewed before

4-23     January 1, 1998, is governed by the law as it existed immediately

4-24     before the effective date of this Act, and that law is continued in

4-25     effect for this purpose.

 5-1           SECTION 3.  The importance of this legislation and the

 5-2     crowded condition of the calendars in both houses create an

 5-3     emergency and an imperative public necessity that the

 5-4     constitutional rule requiring bills to be read on three several

 5-5     days in each house be suspended, and this rule is hereby suspended.

         _______________________________     _______________________________

             President of the Senate              Speaker of the House

               I hereby certify that S.B. No. 172 passed the Senate on

         March 18, 1997, by a viva-voce vote; and that the Senate concurred

         in House amendment on May 24, 1997, by a viva-voce vote.

                                             _______________________________

                                                 Secretary of the Senate

               I hereby certify that S.B. No. 172 passed the House, with

         amendment, on May 21, 1997, by a non-record vote.

                                             _______________________________

                                                 Chief Clerk of the House

         Approved:

         _______________________________

                     Date

         _______________________________

                   Governor