HBA-NIK C.S.H.B. 1650 76(R)BILL ANALYSIS Office of House Bill AnalysisC.S.H.B. 1650 By: Coleman Insurance 4/24/1999 Committee Report (Substituted) BACKGROUND AND PURPOSE Currently, the majority of health insurance policies provided in Texas exclude coverage for injuries or sickness resulting from attempted suicide or intentionally self-inflicted injury. C.S.H.B. 1650 prohibits insurance companies from excluding coverage of self-inflicted wounds when minors are involved. Insurance companies would be required to cover all self-inflicted wounds that occur in either a suicide attempt or as a result of a serious mental illness involving a minor. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that rulemaking authority is expressly delegated to the commissioner of insurance in SECTION 1 (Article 21.53P, Insurance Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53P, as follows: Art. 21.53P. COVERAGE FOR CERTAIN SELF-INFLICTED PHYSICAL INJURIES BY MINORS Sec. 1. DEFINITIONS. Defines "enrollee," "health benefit plan," and "serious mental illness." Sec. 2. SCOPE OF ARTICLE. (a) Provides that this article applies only to a health benefit plan (plan) that provides benefits for medical or surgical expenses for an individual or group insurance policy that is offered by specified providers. (b) Sets forth the plans, insurance, and policies to which this article does not apply. Sec. 3. COVERAGE REQUIRED. Requires a plan, regardless of whether it provides mental health coverage, to cover an enrollee for any self-inflicted physical injury through age 18 in an attempt to commit suicide, regardless of the state of the enrollee's mental health or whether injury results in death of the enrollee. Sec. 4. DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS. Prohibits the benefits required under this article from being made subject to a deductible, coinsurance, or copayment requirement (requirements) that exceeds requirements applicable to other physical injury benefits provided under the plan. Sec. 5. RULES. Requires 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 a plan delivered, issued for delivery, or renewed beginning January 1, 2000. SECTION 3. Emergency clause. COMPARISON OF ORIGINAL TO SUBSTITUTE C.S.H.B. 1650 modifies the original bill in SECTION 1 by changing the title of proposed Article 21.53P to "Coverage for Certain Self-Inflicted Physical Injuries by Minors" by adding the word "physical." The substitute modifies the proposed definition of "serious mental illness" as defined by the American Psychiatric Association's Diagnostic and Statistical Manual designated DSM-IV-R, to DSM-IV. Other changes in SECTION 1 are as follows: The substitute modifies proposed Section 2 of the original bill to remove a plan that provides benefits for medical or surgical expenses for an individual or group insurance policy that is offered by specified providers, and sets forth the plans, insurance, and policies to which this article does not apply from the list of plans to which the article does not apply. The substitute also modifies proposed Section 2 of the original bill by adding that this article does not apply to a small employer health benefit plan written under Chapter 26 (Health Insurance Availability) of this code, except when an independent school district elects to participate in a small employer market in accordance with Article 26.036 (School District Election), Insurance Code. The substitute modifies proposed Section 3 of the original bill to make a conforming change. The substitute removes proposed Section 4 of the original bill, which authorized a health benefit plan to limit the amount of coverage provided under this article to $75,000 for the lifetime of the enrollee. The substitute redesignates proposed Section 5 of the original bill to Section 4 of the substitute. The substitute modifies this section by prohibiting the benefits required under this article from being made subject to a deductible, coinsurance, or copayment requirement that exceeds the deductible, coinsurance, or copayment requirements applicable to other physical injury, rather than similar, benefits provided under the health benefit plan. The substitute redesignates Section 6 to Section 5.