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


Senate Research CenterC.S.S.B. 288
76R10622 DB-DBy: Carona
Economic Development
4/22/1999
Committee Report (Substituted)


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. C.S.S.B. 288
clarifies existing law requiring health plans to define reconstructive
surgery for craniofacial abnormalities for children up to 18 years old. 

PURPOSE

As proposed, C.S.S.B. 288 clarifies existing law requiring 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 (Section 4, 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.  Requires a health benefit plan that provides benefits
to a child who is younger than 18 years of age to define reconstructive
surgery for craniofacial abnormalities to mean surgery to improve the
function or appearance of an abnormal structure caused by congenital
defects, deformities, trauma, tumors, infections, or disease. 

Sec. 4.  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.



 


SUMMARY OF COMMITTEE CHANGES

SECTION 1.

Amends Article 21.53W, Insurance Code, to redefine the term of coverage for
certain minors with craniofacial abnormalities, and to delete proposed
sections regarding prohibitions against preexisting conditions; deductible,
coinsurance, and copayment requirements; limitations; and notice.