By Coleman H.B. No. 1650
76R6848 DB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefit plan coverage for certain injuries that
1-3 are self-inflicted by a minor.
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 21.53P to read as follows:
1-7 Art. 21.53P. COVERAGE FOR CERTAIN SELF-INFLICTED INJURIES BY
1-8 MINORS
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Enrollee" means an individual enrolled in a
1-11 health benefit plan.
1-12 (2) "Health benefit plan" means a plan described by
1-13 Section 2(a) of this article.
1-14 (3) "Serious mental illness" means:
1-15 (A) the following psychiatric illnesses as
1-16 defined by the American Psychiatric Association's Diagnostic and
1-17 Statistical Manual designated DSM-IV-R:
1-18 (i) schizophrenia;
1-19 (ii) paranoid and other psychotic
1-20 disorders;
1-21 (iii) bipolar disorders (hypomanic, manic,
1-22 depressive, and mixed);
1-23 (iv) major depressive disorders (single
1-24 episode or recurrent);
2-1 (v) schizo-affective disorders (bipolar or
2-2 depressive);
2-3 (vi) pervasive developmental disorders;
2-4 (vii) obsessive-compulsive disorders; and
2-5 (viii) depression; or
2-6 (B) a diagnosable behavioral or emotional
2-7 disorder or a neuropsychiatric condition:
2-8 (i) that results in a serious disability
2-9 requiring sustained treatment interventions;
2-10 (ii) that is of sufficient duration to
2-11 meet diagnostic criteria specified in the American Psychiatric
2-12 Association's Diagnostic and Statistical Manual designated
2-13 DSM-IV-R; and
2-14 (iii) with respect to which the person
2-15 exhibits impairment in thought, perception, affect, or behavior
2-16 that substantially interferes with or limits the person's role or
2-17 functioning in the person's community, school, family, or peer
2-18 group.
2-19 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
2-20 a health benefit plan that provides benefits for medical or
2-21 surgical expenses incurred as a result of a health condition,
2-22 accident, or sickness, including an individual, group, blanket, or
2-23 franchise insurance policy or insurance agreement, a group hospital
2-24 service contract, or an individual or group evidence of coverage or
2-25 similar coverage document that is offered by:
2-26 (1) an insurance company;
2-27 (2) a group hospital service corporation operating
3-1 under Chapter 20 of this code;
3-2 (3) a fraternal benefit society operating under
3-3 Chapter 10 of this code;
3-4 (4) a stipulated premium insurance company operating
3-5 under Chapter 22 of this code;
3-6 (5) a reciprocal exchange operating under Chapter 19
3-7 of this code;
3-8 (6) a health maintenance organization operating under
3-9 the Texas Health Maintenance Organization Act (Chapter 20A,
3-10 Vernon's Texas Insurance Code);
3-11 (7) a multiple employer welfare arrangement that holds
3-12 a certificate of authority under Article 3.95-2 of this code;
3-13 (8) an approved nonprofit health corporation that
3-14 holds a certificate of authority issued by the commissioner under
3-15 Article 21.52F of this code;
3-16 (9) an agency of the state under:
3-17 (A) the Texas Employees Uniform Group Insurance
3-18 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code);
3-19 (B) the Texas State College and University
3-20 Employees Uniform Insurance Benefits Act (Article 3.50-3, Vernon's
3-21 Texas Insurance Code); or
3-22 (C) Article 3.50-4 of this code;
3-23 (10) a political subdivision under Chapter 172, Local
3-24 Government Code; or
3-25 (11) a school district in accordance with Section
3-26 22.004, Education Code.
3-27 (b) This article does not apply to:
4-1 (1) a plan that provides coverage:
4-2 (A) only for a specified disease or other
4-3 limited benefit;
4-4 (B) only for accidental death or dismemberment;
4-5 (C) for wages or payments in lieu of wages for a
4-6 period during which an employee is absent from work because of
4-7 sickness or injury;
4-8 (D) as a supplement to liability insurance;
4-9 (E) for credit insurance;
4-10 (F) only for dental or vision care;
4-11 (G) only for hospital expenses; or
4-12 (H) only for indemnity for hospital confinement;
4-13 (2) a small employer health benefit plan written under
4-14 Chapter 26 of this code;
4-15 (3) a Medicare supplemental policy as defined by
4-16 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
4-17 and its subsequent amendments;
4-18 (4) workers' compensation insurance coverage;
4-19 (5) medical payment insurance coverage issued as part
4-20 of a motor vehicle insurance policy; or
4-21 (6) a long-term care policy, including a nursing home
4-22 fixed indemnity policy, unless the commissioner determines that the
4-23 policy provides benefit coverage so comprehensive that the policy
4-24 is a health benefit plan as described by Subsection (a) of this
4-25 section.
4-26 Sec. 3. COVERAGE REQUIRED. Regardless of whether a health
4-27 benefit plan provides mental health coverage, a health benefit plan
5-1 must provide coverage for an enrollee, from birth through the date
5-2 the enrollee is 18 years of age, for an injury to the enrollee that
5-3 is self-inflicted:
5-4 (1) in an attempt to commit suicide, regardless of:
5-5 (A) the state of mental health of the enrollee;
5-6 or
5-7 (B) whether the injury results in the death of
5-8 the enrollee; or
5-9 (2) by an enrollee with a serious mental illness.
5-10 Sec. 4. LIMITATIONS. A health benefit plan may limit the
5-11 amount of coverage provided under this article to $75,000 for the
5-12 lifetime of the enrollee.
5-13 Sec. 5. DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS.
5-14 The benefits required under this article may not be made subject to
5-15 a deductible, coinsurance, or copayment requirement that exceeds
5-16 the deductible, coinsurance, or copayment requirements applicable
5-17 to other similar benefits provided under the health benefit plan.
5-18 Sec. 6. RULES. The commissioner shall adopt rules as
5-19 necessary to administer this article.
5-20 SECTION 2. This Act takes effect September 1, 1999, and
5-21 applies only to a health benefit plan that is delivered, issued for
5-22 delivery, or renewed on or after January 1, 2000. A health benefit
5-23 plan that is delivered, issued for delivery, or renewed before
5-24 January 1, 2000, is governed by the law as it existed immediately
5-25 before the effective date of this Act, and that law is continued in
5-26 effect for that purpose.
5-27 SECTION 3. The importance of this legislation and the
6-1 crowded condition of the calendars in both houses create an
6-2 emergency and an imperative public necessity that the
6-3 constitutional rule requiring bills to be read on three several
6-4 days in each house be suspended, and this rule is hereby suspended.