1-1 By: Van de Putte (Senate Sponsor - Carona) H.B. No. 969 1-2 (In the Senate - Received from the House May 11, 1999; 1-3 May 12, 1999, read first time and referred to Committee on Economic 1-4 Development; May 14, 1999, reported favorably by the following 1-5 vote: Yeas 7, Nays 0; May 14, 1999, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to the definition under certain health benefit plans of 1-9 treatment for craniofacial abnormalities of a child. 1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-11 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-12 amended by adding Article 21.53W to read as follows: 1-13 Art. 21.53W. COVERAGE FOR CRANIOFACIAL ABNORMALITIES 1-14 Sec. 1. DEFINITIONS. In this article: 1-15 (1) "Enrollee" means an individual enrolled in a 1-16 health benefit plan. 1-17 (2) "Health benefit plan" means a plan described by 1-18 Section 2(a) of this article. 1-19 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to 1-20 a health benefit plan that: 1-21 (1) provides benefits for medical or surgical expenses 1-22 incurred as a result of a health condition, accident, or sickness, 1-23 including: 1-24 (A) an individual, group, blanket, or franchise 1-25 insurance policy or insurance agreement, a group hospital service 1-26 contract, or an individual or group evidence of coverage that is 1-27 offered by: 1-28 (i) an insurance company; 1-29 (ii) a group hospital service corporation 1-30 operating under Chapter 20 of this code; 1-31 (iii) a fraternal benefit society 1-32 operating under Chapter 10 of this code; 1-33 (iv) a stipulated premium insurance 1-34 company operating under Chapter 22 of this code; or 1-35 (v) a health maintenance organization 1-36 operating under the Texas Health Maintenance Organization Act 1-37 (Chapter 20A, Vernon's Texas Insurance Code); or 1-38 (B) to the extent permitted by the Employee 1-39 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 1-40 seq.), a health benefit plan that is offered by: 1-41 (i) a multiple employer welfare 1-42 arrangement as defined by Section 3, Employee Retirement Income 1-43 Security Act of 1974 (29 U.S.C. Section 1002); 1-44 (ii) any other entity not licensed under 1-45 this code or another insurance law of this state that contracts 1-46 directly for health care services on a risk-sharing basis, 1-47 including an entity that contracts for health care services on a 1-48 capitation basis; or 1-49 (iii) another analogous benefit 1-50 arrangement; or 1-51 (2) is offered by an approved nonprofit health 1-52 corporation that is certified under Section 5.01(a), Medical 1-53 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 1-54 that holds a certificate of authority issued by the commissioner 1-55 under Article 21.52F of this code. 1-56 (b) This article does not apply to: 1-57 (1) a plan that provides coverage: 1-58 (A) only for a specified disease or other 1-59 limited benefit; 1-60 (B) only for accidental death or dismemberment; 1-61 (C) for wages or payments in lieu of wages for a 1-62 period during which an employee is absent from work because of 1-63 sickness or injury; 1-64 (D) as a supplement to liability insurance; 2-1 (E) for credit insurance; 2-2 (F) only for dental or vision care; or 2-3 (G) only for indemnity for hospital confinement 2-4 or other hospital expenses; 2-5 (2) a small employer health benefit plan written under 2-6 Chapter 26 of this code; 2-7 (3) a Medicare supplemental policy as defined by 2-8 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 2-9 (4) workers' compensation insurance coverage; 2-10 (5) medical payment insurance issued as part of a 2-11 motor vehicle insurance policy; or 2-12 (6) a long-term care policy, including a nursing home 2-13 fixed indemnity policy, unless the commissioner determines that the 2-14 policy provides benefit coverage so comprehensive that the policy 2-15 is a health benefit plan as described by Subsection (a) of this 2-16 section. 2-17 Sec. 3. COVERAGE. A health benefit plan that provides 2-18 benefits to a child who is younger than 18 years of age must define 2-19 reconstructive surgery for craniofacial abnormalities under the 2-20 plan to mean surgery to improve the function of, or to attempt to 2-21 create a normal appearance of, an abnormal structure caused by 2-22 congenital defects, developmental deformities, trauma, tumors, 2-23 infections, or disease. 2-24 Sec. 4. RULES. The commissioner shall adopt rules as 2-25 necessary to administer this article. 2-26 SECTION 2. This Act takes effect September 1, 1999, and 2-27 applies only to a health benefit plan that is delivered, issued for 2-28 delivery, or renewed on or after January 1, 2000. A health benefit 2-29 plan that is delivered, issued for delivery, or renewed before 2-30 January 1, 2000, is governed by the law as it existed immediately 2-31 before the effective date of this Act, and that law is continued in 2-32 effect for that purpose. 2-33 SECTION 3. The importance of this legislation and the 2-34 crowded condition of the calendars in both houses create an 2-35 emergency and an imperative public necessity that the 2-36 constitutional rule requiring bills to be read on three several 2-37 days in each house be suspended, and this rule is hereby suspended. 2-38 * * * * *