SRC-JBJ S.B. 288 76(R)   BILL ANALYSIS


Senate Research Center   S.B. 288
76R4483 DB-DBy: Carona
Economic Development
3/15/1999
As Filed


DIGEST 

Under current Texas law, a health plan that offers benefits for individuals
enrolled in certain insurance plans must automatically issue coverage to a
newborn for congenital defects or abnormalities in the infant's first 31
days of life.  Otherwise, the providers have no continuing obligation.
This bill provides coverage for a child from birth to 18 years of age.  The
plan must cover medical procedures to treat abnormal structures of the head
and neck, including cranialfacial deformities caused by congenital defects
or abnormalities, but not cosmetic surgery procedures.  S.B. 288 requires
certain health benefit plans to cover congenital defects or abnormalities
for children up to 18 years old. 

PURPOSE

As proposed, S.B. 288 requires certain health benefit plans to cover
medical procedures to treat congenital defects or abnormalities for
children up to 18 years old. 

RULEMAKING AUTHORITY

Rulemaking authority is granted to the Commissioner of the Texas Department
of Insurance in SECTION 1 (Article 21.53W, Chapter 21E, Insurance Code) of
this bill. 

SECTION BY SECTION ANALYSIS

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

 Art. 21.53W.  COVERAGE FOR CRANIOFACIAL ABNORMALITIES

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

Sec. 2.  SCOPE OF ARTICLE.  Applies this article to certain health
insurance providers and other insurance companies.  Sets forth the criteria
for a company that qualifies under this article. Provides that this article
does not apply to certain situations and policies.  Sets forth the
situations and policies to which this article does not apply. 

Sec. 3.  COVERAGE REQUIRED.  Requires a health benefit plan to provide
benefits to a child of an enrollee who may have a condition under
Subsection (c), from birth through 18 years of age, for certain medical
procedures and treatments.  Sets forth conditions to provide the procedures
and treatments.  Entitles a child to benefits under this section if the
child would be entitled to the health benefit plan under Article 3.70-2,
V.T.I.C. 

Sec. 4.  PREEXISTING CONDITION RESTRICTION PROHIBITED.  Prohibits any
provision from denying, excluding, or limiting coverage of the benefits
under this section. 

Sec. 5.  DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS. Prohibits the
benefits under this article to from being made subject to a deductible,
coinsurance, or copayment requirement that exceeds those requirements
applicable to other similar benefits provided under the health insurance
plan.   

Sec. 6.  LIMITATIONS.  Prohibits coverage under this article for cosmetic
surgery purposes, except as provided by Section 3(a)(2), to solely improve
an enrollee's appearance or self-esteem. 

Sec. 7.  NOTICE.  Requires all health benefit plans to provide each
enrollee under the plan  written notice regarding the coverage under this
article. 

Sec. 8.  RULES.  Requires the Commissioner of the Texas Department of
Insurance to adopt rules 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.