1-1 By: Carona S.B. No. 288 1-2 (In the Senate - Filed January 27, 1999; February 1, 1999, 1-3 read first time and referred to Committee on Economic Development; 1-4 April 23, 1999, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 4, Nays 0; April 23, 1999, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 288 By: Carona 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to the definition under certain health benefit plans of 1-11 treatment for craniofacial abnormalities of a child. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-14 amended by adding Article 21.53W to read as follows: 1-15 Art. 21.53W. COVERAGE FOR CRANIOFACIAL ABNORMALITIES 1-16 Sec. 1. DEFINITIONS. In this article: 1-17 (1) "Enrollee" means an individual enrolled in a 1-18 health benefit plan. 1-19 (2) "Health benefit plan" means a plan described by 1-20 Section 2(a) of this article. 1-21 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to 1-22 a health benefit plan that: 1-23 (1) provides benefits for medical or surgical expenses 1-24 incurred as a result of a health condition, accident, or sickness, 1-25 including: 1-26 (A) an individual, group, blanket, or franchise 1-27 insurance policy or insurance agreement, a group hospital service 1-28 contract, or an individual or group evidence of coverage that is 1-29 offered by: 1-30 (i) an insurance company; 1-31 (ii) a group hospital service corporation 1-32 operating under Chapter 20 of this code; 1-33 (iii) a fraternal benefit society 1-34 operating under Chapter 10 of this code; 1-35 (iv) a stipulated premium insurance 1-36 company operating under Chapter 22 of this code; or 1-37 (v) a health maintenance organization 1-38 operating under the Texas Health Maintenance Organization Act 1-39 (Chapter 20A, Vernon's Texas Insurance Code); or 1-40 (B) to the extent permitted by the Employee 1-41 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 1-42 seq.), a health benefit plan that is offered by: 1-43 (i) a multiple employer welfare 1-44 arrangement as defined by Section 3, Employee Retirement Income 1-45 Security Act of 1974 (29 U.S.C. Section 1002); 1-46 (ii) any other entity not licensed under 1-47 this code or another insurance law of this state that contracts 1-48 directly for health care services on a risk-sharing basis, 1-49 including an entity that contracts for health care services on a 1-50 capitation basis; or 1-51 (iii) another analogous benefit 1-52 arrangement; or 1-53 (2) is offered by an approved nonprofit health 1-54 corporation that is certified under Section 5.01(a), Medical 1-55 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 1-56 that holds a certificate of authority issued by the commissioner 1-57 under Article 21.52F of this code. 1-58 (b) This article does not apply to: 1-59 (1) a plan that provides coverage: 1-60 (A) only for a specified disease or other 1-61 limited benefit; 1-62 (B) only for accidental death or dismemberment; 1-63 (C) for wages or payments in lieu of wages for a 1-64 period during which an employee is absent from work because of 2-1 sickness or injury; 2-2 (D) as a supplement to liability insurance; 2-3 (E) for credit insurance; 2-4 (F) only for dental or vision care; or 2-5 (G) only for indemnity for hospital confinement 2-6 or other hospital expenses; 2-7 (2) a small employer health benefit plan written under 2-8 Chapter 26 of this code; 2-9 (3) a Medicare supplemental policy as defined by 2-10 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 2-11 (4) workers' compensation insurance coverage; 2-12 (5) medical payment insurance issued as part of a 2-13 motor vehicle insurance policy; or 2-14 (6) a long-term care policy, including a nursing home 2-15 fixed indemnity policy, unless the commissioner determines that the 2-16 policy provides benefit coverage so comprehensive that the policy 2-17 is a health benefit plan as described by Subsection (a) of this 2-18 section. 2-19 Sec. 3. COVERAGE. A health benefit plan that provides 2-20 benefits to a child who is younger than 18 years of age must define 2-21 reconstructive surgery for craniofacial abnormalities under the 2-22 plan to mean surgery to improve the function of, or to attempt to 2-23 create a normal appearance of, an abnormal structure caused by 2-24 congenital defects, developmental deformities, trauma, tumors, 2-25 infections, or disease. 2-26 Sec. 4. RULES. The commissioner shall adopt rules as 2-27 necessary to administer this article. 2-28 SECTION 2. This Act takes effect September 1, 1999, and 2-29 applies only to a health benefit plan that is delivered, issued for 2-30 delivery, or renewed on or after January 1, 2000. A health benefit 2-31 plan that is delivered, issued for delivery, or renewed before 2-32 January 1, 2000, is governed by the law as it existed immediately 2-33 before the effective date of this Act, and that law is continued in 2-34 effect for that purpose. 2-35 SECTION 3. The importance of this legislation and the 2-36 crowded condition of the calendars in both houses create an 2-37 emergency and an imperative public necessity that the 2-38 constitutional rule requiring bills to be read on three several 2-39 days in each house be suspended, and this rule is hereby suspended. 2-40 * * * * *