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.