By Flores 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.