SRC-JXG H.B. 969 76(R)   BILL ANALYSIS


Senate Research Center   H.B. 969
76R10622 DB-DBy: Van de Putte (Carona)
Economic Development
5/13/1999
Engrossed


DIGEST 

Currently, Texas law does not require health benefit plans to cover the
treatment of a child for congenital developmental defects or diseases.
However, policies that provide maternity or dependent coverage must provide
automatic coverage to a newborn child for congenital defects or
abnormalities for the initial 31 days.  H.B. 969 provides that a health
benefit plan that provides benefits to a child who is younger than 18 years
of age must define reconstructive surgery for craniofacial abnormalities
under the plan to mean surgery to improve the function of, or to attempt to
create a normal appearance of, an abnormal structure caused by congenital
defects, developmental deformities, trauma, tumors, infections, or disease.

PURPOSE

As proposed, H.B. 969 sets forth provisions regarding coverage for
craniofacial abnormalities under certain health benefit plans.  

RULEMAKING AUTHORITY

Rulemaking authority  is granted to the commissioner of insurance in
SECTION 1 (Section 4, Article 21.53W, Insurance Code) of this bill.  

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding
Article 21.53W, as follows:  

ARTICLE 21.53W. COVERAGE FOR CRANIOFACIAL ABNORMALITIES

 Sec. 1. DEFINITIONS. Defines "enrollee" and "health benefit plan."

Sec. 2. SCOPE OF ARTICLE.  Provides that this article applies to a health
benefit plan that provides certain benefits.  Sets forth provisions that do
not apply to this article. 

Sec. 3. COVERAGE. Provides that a health benefit plan that provides
benefits to a child who is younger than 18 years of age must define
reconstructive surgery for craniofacial abnormalities under the plan to
mean surgery to improve the function of, or to attempt to create a normal
appearance of, an abnormal structure caused by congenital defects,
developmental deformities, trauma, tumors, infections, or disease.  

Sec. 4. RULES. Authorizes the commissioner of insurance to adopt rules as
necessary to administer this article.  

SECTION 2. Effective date: September 1, 1999. 
           Makes application of this Act prospective to January 1, 2000.

SECTION 3. Emergency clause.