HBA-ATS H.B. 3053 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 3053 By: Reyna, Elvira Insurance 4/19/1999 Introduced BACKGROUND AND PURPOSE To breastfeed or not to breastfeed is a question faced by many new or expectant mothers. Although breastfeeding has suffered from social stigma, public attitudes toward breastfeeding are changing. This is probably due to scientific evidence that indicates that breastfeeding protects infants from infection, prevents allergies in infants, decreases diarrhea in infants, and decreases infant mortality and infant obesity. In addition, more recent research suggests that breast milk provides protection to newborns from major illnesses such as childhood diabetes (insulin dependent diabetes mellitus), gastrointestinal diseases, and some types of cancer (lymphomas). Other studies indicate that mothers who breastfeed have fewer instances of breast and ovarian cancer. All of these factors relate to lower health care costs for women and children. A mother who chooses to breastfeed is likely to be dependent upon help from health professionals for advice about breastfeeding. Many of these health professionals are International Board of Lactation Consultant Examiners certified lactation consultants who assist mothers with their breastfeeding questions and concerns and provide breastfeeding-related products and services. Without insurance coverage, the use of a lactation consultant may be cost prohibitive for many women. H.B. 3053 sets forth that a health benefit plan that provides maternity benefits must provide coverage for a lactation consultant requested by the enrollee during pregnancy and for one year after the date of delivery of the enrollee's child. Although these benefits may be made subject to a deductible, copayment, or coinsurance requirement, the deductible, copayment, or coinsurance is prohibited from exceeding the deductible, copayment, or coinsurance required by the plan for any other maternity benefit. 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 21.53Q, Insurance Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53Q, as follows: ARTICLE 21.53Q. COVERAGE FOR SERVICES OF LACTATION CONSULTANT Sec. 1. DEFINITIONS. Defines "enrollee," "health benefit plan," and "lactation consultant." Sec. 2. SCOPE OF ARTICLE. (a) Specifies that Article 21.53Q applies only to a health benefit plan (plan) that provides benefits for medical or surgical expenses incurred because of a health condition, accident, or sickness. These types of plans include an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, and individual or group coverage. Specifies that these plans are offered by an insurance company; a group hospital service corporation; a fraternal benefit society; a stipulated premium insurance company; a reciprocal exchange; a health maintenance organization; a multiple employer welfare arrangement; and an approved nonprofit health corporation. (b) Provides that Article 21.53Q does not apply to a plan that provides coverage only for a specific disease or other limited benefit; only for accidental death or dismemberment; for wages or payments for a period during which an employee is absent from work because of sickness or injury; as a supplement to liability insurance; for credit insurance; only for dental or vision care; only for hospital expenses; or only for indemnity for hospital confinement. Also excluded is a small employer health benefit plan; a Medicare supplemental policy; workers' compensation insurance coverage; medical payment insurance coverage issued as part of a motor vehicle insurance policy; or a long-term care policy. Sec. 3. COVERAGE REQUIRED. Sets forth that a plan that provides maternity benefits must provide coverage for a lactation consultant requested by the enrollee during pregnancy and for one year after the date of delivery of the enrollee's child. Authorizes these benefits to be made subject to a deductible, copayment, or coinsurance requirement. Prohibits the possible deductible, copayment, or coinsurance from exceeding the deductible, copayment, or coinsurance required by the plan for any other maternity benefit. Sec. 4. RULES. Authorizes the commissioner of insurance to adopt rules necessary to administer this article. SECTION 2.Effective date: September 1, 1999. Makes application of this Act prospective for a plan that is delivered, issued for delivery, or renewed on or after January 1, 2000. SECTION 3. Emergency clause.