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