By: Zaffirini, West S.B. No. 172
A BILL TO BE ENTITLED
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 Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS.
3-11 (a) A health benefit plan that provides benefits for a family
3-12 member of the insured shall provide coverage for each covered child
3-13 described by Subsection (b) of this section, from birth through the
3-14 date the child is six years of age, for:
3-15 (1) immunization against:
3-16 (A) diphtheria;
3-17 (B) haemophilus influenzae type b;
3-18 (C) hepatitis B;
3-19 (D) measles;
3-20 (E) mumps;
3-21 (F) pertussis;
3-22 (G) polio;
3-23 (H) rubella;
3-24 (I) tetanus; and
3-25 (J) varicella; and
4-1 (2) any other immunization that is required by law for
4-2 the child.
4-3 (b) A child is entitled to benefits under this section if
4-4 the child, as a result of the child's relationship to an enrollee
4-5 in the health benefit plan, would be entitled to benefits under an
4-6 accident and sickness insurance policy under Subsection (K), (L),
4-7 or (M), Section 2, Chapter 397, Acts of the 54th Legislature, 1955
4-8 (Article 3.70-2, Vernon's Texas Insurance Code).
4-9 Sec. 4. FIRST DOLLAR COVERAGE REQUIRED. (a) Benefits
4-10 required under Section 3 of this article may not be made subject to
4-11 a deductible, copayment, or coinsurance requirement.
4-12 (b) Subsection (a) of this section does not prohibit the
4-13 application of a deductible, copayment, or coinsurance requirement
4-14 to another service provided at the same time as the immunization.
4-15 SECTION 2. This Act takes effect September 1, 1997, and
4-16 applies only to a health benefit plan that is delivered, issued for
4-17 delivery, or renewed on or after January 1, 1998. A health benefit
4-18 plan that is delivered, issued for delivery, or renewed before
4-19 January 1, 1998, is governed by the law as it existed immediately
4-20 before the effective date of this Act, and that law is continued in
4-21 effect for this purpose.
4-22 SECTION 3. The importance of this legislation and the
4-23 crowded condition of the calendars in both houses create an
4-24 emergency and an imperative public necessity that the
4-25 constitutional rule requiring bills to be read on three several
5-1 days in each house be suspended, and this rule is hereby suspended.
< By: Zaffirini, West S.B. No. 172