By Burnam H.B. No. 1093
76R3671 AJA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefit plan coverage for the services of a
1-3 labor support specialist during childbirth.
1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-6 amended by adding Article 21.53O to read as follows:
1-7 Art. 21.53O. COVERAGE FOR SERVICES OF LABOR SUPPORT
1-8 SPECIALIST
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Enrollee" means a person entitled to coverage
1-11 under a health benefit plan.
1-12 (2) "Health benefit plan" means a plan described by
1-13 Section 2 of this article.
1-14 (3) "Labor support specialist" means a person who is
1-15 professionally trained to provide physical, emotional, and
1-16 informational support to a pregnant woman during labor and
1-17 delivery.
1-18 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-19 a health benefit plan that provides benefits for medical or
1-20 surgical expenses incurred as a result of a health condition,
1-21 accident, or sickness, including an individual, group, blanket, or
1-22 franchise insurance policy or insurance agreement, a group hospital
1-23 service contract, or an individual or group evidence of coverage or
1-24 similar coverage document that is offered by:
2-1 (1) an insurance company;
2-2 (2) a group hospital service corporation operating
2-3 under Chapter 20 of this code;
2-4 (3) a fraternal benefit society operating under
2-5 Chapter 10 of this code;
2-6 (4) a stipulated premium insurance company operating
2-7 under Chapter 22 of this code;
2-8 (5) a reciprocal exchange operating under Chapter 19
2-9 of this code;
2-10 (6) a health maintenance organization operating under
2-11 the Texas Health Maintenance Organization Act (Chapter 20A,
2-12 Vernon's Texas Insurance Code);
2-13 (7) a multiple employer welfare arrangement that holds
2-14 a certificate of authority under Article 3.95-2 of this code; or
2-15 (8) an approved nonprofit health corporation that
2-16 holds a certificate of authority issued by the commissioner under
2-17 Article 21.52F of this code.
2-18 (b) This article does not apply to:
2-19 (1) a plan that provides coverage:
2-20 (A) only for a specified disease or other
2-21 limited benefit;
2-22 (B) only for accidental death or dismemberment;
2-23 (C) for wages or payments in lieu of wages for a
2-24 period during which an employee is absent from work because of
2-25 sickness or injury;
2-26 (D) as a supplement to liability insurance;
2-27 (E) for credit insurance;
3-1 (F) only for dental or vision care;
3-2 (G) only for hospital expenses; or
3-3 (H) only for indemnity for hospital confinement;
3-4 (2) a small employer health benefit plan written under
3-5 Chapter 26 of this code;
3-6 (3) a Medicare supplemental policy as defined by
3-7 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-8 as amended;
3-9 (4) workers' compensation insurance coverage;
3-10 (5) medical payment insurance coverage issued as part
3-11 of a motor vehicle insurance policy; or
3-12 (6) a long-term care policy, including a nursing home
3-13 fixed indemnity policy, unless the commissioner determines that the
3-14 policy provides benefit coverage so comprehensive that the policy
3-15 is a health benefit plan as described by Subsection (a) of this
3-16 section.
3-17 Sec. 3. COVERAGE REQUIRED. (a) A health benefit plan that
3-18 provides maternity benefits, including benefits for childbirth,
3-19 must include coverage for the services of a labor support
3-20 specialist during labor and delivery on request of a pregnant
3-21 enrollee.
3-22 (b) Benefits required under this article may be made subject
3-23 to a deductible, copayment, or coinsurance requirement. A
3-24 deductible, copayment, or coinsurance required by the health
3-25 benefit plan for benefits under this article may not exceed the
3-26 deductible, copayment, or coinsurance required by the health
3-27 benefit plan for any other maternity benefit.
4-1 Sec. 4. RULES. The commissioner shall adopt rules as
4-2 necessary to administer this article.
4-3 SECTION 2. This Act takes effect September 1, 1999, and
4-4 applies only to a health benefit plan that is delivered, issued for
4-5 delivery, or renewed on or after January 1, 2000. A health benefit
4-6 plan delivered, issued for delivery, or renewed before January 1,
4-7 2000, is governed by the law as it existed immediately before the
4-8 effective date of this Act, and that law is continued in effect for
4-9 that purpose.
4-10 SECTION 3. The importance of this legislation and the
4-11 crowded condition of the calendars in both houses create an
4-12 emergency and an imperative public necessity that the
4-13 constitutional rule requiring bills to be read on three several
4-14 days in each house be suspended, and this rule is hereby suspended.