1-1 By: Zaffirini, West S.B. No. 172 1-2 (In the Senate - Filed January 7, 1997; January 15, 1997, 1-3 read first time and referred to Committee on Health and Human 1-4 Services; March 10, 1997, reported adversely, with favorable 1-5 Committee Substitute by the following vote: Yeas 11, Nays 0; 1-6 March 10, 1997, sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 172 By: Zaffirini 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to coverage for childhood immunizations under certain 1-11 health benefit plans. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-14 amended by adding Article 21.53F to read as follows: 1-15 Art. 21.53F. COVERAGE FOR CHILDHOOD IMMUNIZATIONS 1-16 Sec. 1. DEFINITION. In this article, "health benefit plan" 1-17 means a plan described by Section 2 of this article. 1-18 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to 1-19 a health benefit plan that: 1-20 (1) provides benefits for medical or surgical expenses 1-21 incurred as a result of a health condition, accident, or sickness, 1-22 including an individual, group, blanket, or franchise insurance 1-23 policy or insurance agreement, a group hospital service contract, 1-24 or an individual or group evidence of coverage that is offered by: 1-25 (A) an insurance company; 1-26 (B) a group hospital service corporation 1-27 operating under Chapter 20 of this code; 1-28 (C) a fraternal benefit society operating under 1-29 Chapter 10 of this code; 1-30 (D) a stipulated premium insurance company 1-31 operating under Chapter 22 of this code; 1-32 (E) a health maintenance organization operating 1-33 under the Texas Health Maintenance Organization Act (Chapter 20A, 1-34 Vernon's Texas Insurance Code); or 1-35 (F) a multiple employer welfare arrangement 1-36 subject to regulation under Subchapter I, Chapter 3 of this code; 1-37 or 1-38 (2) is offered by an approved nonprofit health 1-39 corporation that is certified under Section 5.01(a), Medical 1-40 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 1-41 that holds a certificate of authority issued by the commissioner 1-42 under Article 21.52F of this code. 1-43 (b) This article does not apply to: 1-44 (1) a plan that provides coverage: 1-45 (A) only for a specified disease or other 1-46 limited benefit; 1-47 (B) only for accidental death or dismemberment; 1-48 (C) for wages or payments in lieu of wages for a 1-49 period during which an employee is absent from work because of 1-50 sickness or injury; 1-51 (D) as a supplement to liability insurance; 1-52 (E) for credit insurance; 1-53 (F) only for dental or vision care; or 1-54 (G) only for indemnity for hospital confinement; 1-55 (2) a small employer health benefit plan written under 1-56 Chapter 26 of this code; 1-57 (3) a Medicare supplemental policy as defined by 1-58 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 1-59 (4) workers' compensation insurance coverage; 1-60 (5) medical payment insurance issued as part of a 1-61 motor vehicle insurance policy; or 1-62 (6) a long-term care policy, including a nursing home 1-63 fixed indemnity policy, unless the commissioner determines that the 1-64 policy provides benefit coverage so comprehensive that the policy 2-1 is a health benefit plan as described by Subsection (a) of this 2-2 section. 2-3 Sec. 3. REQUIRED BENEFIT FOR CHILDHOOD IMMUNIZATIONS. 2-4 (a) A health benefit plan that provides benefits for a family 2-5 member of the insured shall provide coverage for each child 2-6 described by Subsection (b) of this section, from birth through the 2-7 date the child is six years of age, for: 2-8 (1) immunization against: 2-9 (A) diphtheria; 2-10 (B) haemophilus influenzae type b; 2-11 (C) hepatitis B; 2-12 (D) measles; 2-13 (E) mumps; 2-14 (F) pertussis; 2-15 (G) polio; 2-16 (H) rubella; 2-17 (I) tetanus; and 2-18 (J) varicella; and 2-19 (2) any other immunization that is required by law for 2-20 the child. 2-21 (b) A child is entitled to benefits under this section if 2-22 the child, as a result of the child's relationship to an enrollee 2-23 in the health benefit plan, would be entitled to benefits under an 2-24 accident and sickness insurance policy under Subsection (K), (L), 2-25 or (M), Section 2, Chapter 397, Acts of the 54th Legislature, 1955 2-26 (Article 3.70-2, Vernon's Texas Insurance Code). 2-27 Sec. 4. FIRST DOLLAR COVERAGE REQUIRED. (a) Benefits 2-28 required under Section 3 of this article may not be made subject to 2-29 a deductible, copayment, or coinsurance requirement. 2-30 (b) Subsection (a) of this section does not prohibit the 2-31 application of a deductible, copayment, or coinsurance requirement 2-32 to another service provided at the same time as the immunization. 2-33 SECTION 2. This Act takes effect September 1, 1997, and 2-34 applies only to a health benefit plan that is delivered, issued for 2-35 delivery, or renewed on or after January 1, 1998. A health benefit 2-36 plan that is delivered, issued for delivery, or renewed before 2-37 January 1, 1998, is governed by the law as it existed immediately 2-38 before the effective date of this Act, and that law is continued in 2-39 effect for this purpose. 2-40 SECTION 3. The importance of this legislation and the 2-41 crowded condition of the calendars in both houses create an 2-42 emergency and an imperative public necessity that the 2-43 constitutional rule requiring bills to be read on three several 2-44 days in each house be suspended, and this rule is hereby suspended. 2-45 * * * * *