By Zaffirini S.B. No. 172 75R3339 DLF-F A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to coverage for childhood immunizations under certain 1-3 health benefit plans. 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 21.53F to read as follows: 1-7 Art. 21.53F. COVERAGE FOR CHILDHOOD IMMUNIZATIONS 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 to a 1-11 health benefit plan that: 1-12 (1) provides benefits for medical or surgical expenses 1-13 incurred as a result of a health condition, accident, or sickness, 1-14 including: 1-15 (A) an individual, group, blanket, or franchise 1-16 insurance policy or insurance agreement, a group hospital service 1-17 contract, or an individual or group evidence of coverage that is 1-18 offered by: 1-19 (i) an insurance company; 1-20 (ii) a group hospital service corporation 1-21 operating under Chapter 20 of this code; 1-22 (iii) a fraternal benefit society 1-23 operating under Chapter 10 of this code; 1-24 (iv) a stipulated premium insurance 2-1 company operating under Chapter 22 of this code; or 2-2 (v) a health maintenance organization 2-3 operating under the Texas Health Maintenance Organization Act 2-4 (Chapter 20A, Vernon's Texas Insurance Code); or 2-5 (B) to the extent permitted by the Employee 2-6 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 2-7 seq.), a health benefit plan that is offered by: 2-8 (i) a multiple employer welfare 2-9 arrangement as defined by Section 3, Employee Retirement Income 2-10 Security Act of 1974 (29 U.S.C. Section 1002); or 2-11 (ii) another analogous benefit 2-12 arrangement; 2-13 (2) is offered by an approved non-profit health 2-14 corporation that is certified under Section 5.01(a), Medical 2-15 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 2-16 that holds a certificate of authority issued by the commissioner 2-17 under Article 21.52F of this code; or 2-18 (3) is offered by any other entity not licensed under 2-19 this code or another insurance law of this state that contracts 2-20 directly for health care services on a risk sharing basis, 2-21 including an entity that contracts for health care services on a 2-22 capitation basis. 2-23 (b) This article does not apply to: 2-24 (1) a plan that provides coverage: 2-25 (A) only for a specified disease; 2-26 (B) only for accidental death or dismemberment; 2-27 (C) for wages or payments in lieu of wages for a 3-1 period during which an employee is absent from work because of 3-2 sickness or injury; or 3-3 (D) as a supplement to liability insurance; 3-4 (2) a plan written under Chapter 26 of this code; 3-5 (3) a Medicare supplemental policy as defined by 3-6 Section 1882(g)(1), Social Security Act (42 U.S.C. 1395ss); 3-7 (4) workers' compensation insurance coverage; 3-8 (5) medical payment insurance issued as part of a 3-9 motor vehicle insurance policy; or 3-10 (6) a long-term care policy, including a nursing home 3-11 fixed indemnity policy, unless the commissioner determines that the 3-12 policy provides benefit coverage so comprehensive that the policy 3-13 is a health benefit plan as described by Subsection (a) of this 3-14 section. 3-15 Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. A 3-16 health benefit plan that provides benefits for a family member of 3-17 the insured shall provide coverage for each newly born child of the 3-18 insured, from birth through the date the child is six years of age, 3-19 for: 3-20 (1) immunization against: 3-21 (A) diphtheria; 3-22 (B) haemophilus influenzae type b; 3-23 (C) hepatitis B; 3-24 (D) measles; 3-25 (E) mumps; 3-26 (F) pertussis; 3-27 (G) polio; 4-1 (H) rubella; 4-2 (I) tetanus; and 4-3 (J) varicella; and 4-4 (2) any other immunization that the commissioner 4-5 determines to be required by law for the child. 4-6 Sec. 4. FIRST DOLLAR COVERAGE REQUIRED. Benefits required 4-7 under Section 3 may not be made subject to a deductible, copayment, 4-8 or coinsurance requirement. 4-9 SECTION 2. This Act takes effect September 1, 1997, and 4-10 applies only to a health benefit plan that is delivered, issued for 4-11 delivery, or renewed on or after January 1, 1998. A health 4-12 benefit plan that is delivered, issued for delivery, or renewed 4-13 before January 1, 1998, is governed by the law as it existed 4-14 immediately before the effective date of this Act, and that law is 4-15 continued in effect for this purpose. 4-16 SECTION 3. The importance of this legislation and the 4-17 crowded condition of the calendars in both houses create an 4-18 emergency and an imperative public necessity that the 4-19 constitutional rule requiring bills to be read on three several 4-20 days in each house be suspended, and this rule is hereby suspended.