By Flores, Wise H.B. No. 3584 76R4233 DB-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to dependent coverage under certain group health benefit 1-3 plans. 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 21.53M to read as follows: 1-7 Art. 21.53M. DEPENDENT COVERAGE DEFINED 1-8 Sec. 1. DEFINITIONS. In this article: 1-9 (1) "Enrollee" means an individual enrolled in a 1-10 health benefit plan. 1-11 (2) "Health benefit plan" means a plan described by 1-12 Section 2(a) of this article. 1-13 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to 1-14 a health benefit plan that provides benefits for medical or 1-15 surgical expenses incurred as a result of a health condition, 1-16 accident, or sickness, including an individual, group, blanket, or 1-17 franchise insurance policy or insurance agreement, a group hospital 1-18 service contract, or an individual or group evidence of coverage or 1-19 similar coverage document that is offered by: 1-20 (1) an insurance company; 1-21 (2) a group hospital service corporation operating 1-22 under Chapter 20 of this code; 1-23 (3) a fraternal benefit society operating under 1-24 Chapter 10 of this code; 2-1 (4) a stipulated premium insurance company operating 2-2 under Chapter 22 of this code; 2-3 (5) a reciprocal exchange operating under Chapter 19 2-4 of this code; 2-5 (6) a health maintenance organization operating under 2-6 the Texas Health Maintenance Organization Act (Chapter 20A, 2-7 Vernon's Texas Insurance Code); 2-8 (7) a multiple employer welfare arrangement that holds 2-9 a certificate of authority under Article 3.95-2 of this code; or 2-10 (8) an approved nonprofit health corporation that 2-11 holds a certificate of authority issued by the commissioner under 2-12 Article 21.52F of this code. 2-13 (b) This article does not apply to: 2-14 (1) a plan that provides coverage: 2-15 (A) only for a specified disease or other 2-16 limited benefit; 2-17 (B) only for accidental death or dismemberment; 2-18 (C) for wages or payments in lieu of wages for a 2-19 period during which an employee is absent from work because of 2-20 sickness or injury; 2-21 (D) as a supplement to liability insurance; 2-22 (E) for credit insurance; 2-23 (F) only for dental or vision care; 2-24 (G) only for hospital expenses; or 2-25 (H) only for indemnity for hospital confinement; 2-26 (2) a small employer health benefit plan written under 2-27 Chapter 26 of this code; 3-1 (3) a Medicare supplemental policy as defined by 3-2 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 3-3 as amended; 3-4 (4) workers' compensation insurance coverage; 3-5 (5) medical payment insurance coverage issued as part 3-6 of a motor vehicle insurance policy; or 3-7 (6) a long-term care policy, including a nursing home 3-8 fixed indemnity policy, unless the commissioner determines that the 3-9 policy provides benefit coverage so comprehensive that the policy 3-10 is a health benefit plan as described by Subsection (a) of this 3-11 section. 3-12 Sec. 3. CHILD COVERAGE REQUIRED. Notwithstanding any other 3-13 law, a health benefit plan that provides coverage for a child who 3-14 is a dependent of an enrollee must provide coverage for a child of 3-15 the enrollee, including an adopted child, stepchild, foster child, 3-16 or other child who is in a regular parent-child relationship with 3-17 the enrollee, for as long as the child is: 3-18 (1) younger than 25 years of age; and 3-19 (2) unmarried. 3-20 Sec. 4. DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS. 3-21 The benefits required under this article may not be made subject to 3-22 a deductible, coinsurance, or copayment requirement that exceeds 3-23 the deductible, coinsurance, or copayment requirements applicable 3-24 to other similar benefits provided under the health benefit plan. 3-25 Sec. 5. RULES. The commissioner shall adopt rules as 3-26 necessary to administer this article. 3-27 SECTION 2. This Act takes effect September 1, 1999, and 4-1 applies only to a health benefit plan that is delivered, issued for 4-2 delivery, or renewed on or after January 1, 2000. A health benefit 4-3 plan that is delivered, issued for delivery, or renewed before 4-4 January 1, 2000, is governed by the law as it existed immediately 4-5 before the effective date of this Act, and that law is continued in 4-6 effect for that purpose. 4-7 SECTION 3. The importance of this legislation and the 4-8 crowded condition of the calendars in both houses create an 4-9 emergency and an imperative public necessity that the 4-10 constitutional rule requiring bills to be read on three several 4-11 days in each house be suspended, and this rule is hereby suspended.