By Moncrief S.B. No. 1349
76R5285 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 lactation consultant.
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 21.53Q to read as follows:
1-7 Art. 21.53Q. COVERAGE FOR SERVICES OF LACTATION CONSULTANT
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Enrollee" means a person entitled to coverage
1-10 under a health benefit plan.
1-11 (2) "Health benefit plan" means a plan described by
1-12 Section 2 of this article.
1-13 (3) "Lactation consultant" means a person who is
1-14 certified by the International Board of Lactation Consultant
1-15 Examiners.
1-16 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-17 a health benefit plan that provides benefits for medical or
1-18 surgical expenses incurred as a result of a health condition,
1-19 accident, or sickness, including an individual, group, blanket, or
1-20 franchise insurance policy or insurance agreement, a group hospital
1-21 service contract, or an individual or group evidence of coverage or
1-22 similar coverage document that is offered by:
1-23 (1) an insurance company;
1-24 (2) a group hospital service corporation operating
2-1 under Chapter 20 of this code;
2-2 (3) a fraternal benefit society operating under
2-3 Chapter 10 of this code;
2-4 (4) a stipulated premium insurance company operating
2-5 under Chapter 22 of this code;
2-6 (5) a reciprocal exchange operating under Chapter 19
2-7 of this code;
2-8 (6) a health maintenance organization operating under
2-9 the Texas Health Maintenance Organization Act (Chapter 20A,
2-10 Vernon's Texas Insurance Code);
2-11 (7) a multiple employer welfare arrangement that holds
2-12 a certificate of authority under Article 3.95-2 of this code; or
2-13 (8) an approved nonprofit health corporation that
2-14 holds a certificate of authority issued by the commissioner under
2-15 Article 21.52F of this code.
2-16 (b) This article does not apply to:
2-17 (1) a plan that provides coverage:
2-18 (A) only for a specified disease or other
2-19 limited benefit;
2-20 (B) only for accidental death or dismemberment;
2-21 (C) for wages or payments in lieu of wages for a
2-22 period during which an employee is absent from work because of
2-23 sickness or injury;
2-24 (D) as a supplement to liability insurance;
2-25 (E) for credit insurance;
2-26 (F) only for dental or vision care;
2-27 (G) only for hospital expenses; or
3-1 (H) only for indemnity for hospital confinement;
3-2 (2) a small employer health benefit plan written under
3-3 Chapter 26 of this code;
3-4 (3) a Medicare supplemental policy as defined by
3-5 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-6 as amended;
3-7 (4) workers' compensation insurance coverage;
3-8 (5) medical payment insurance coverage issued as part
3-9 of a motor vehicle insurance policy; or
3-10 (6) a long-term care policy, including a nursing home
3-11 fixed indemnity policy, unless the commissioner determines that the
3-12 policy provides benefit coverage so comprehensive that the policy
3-13 is a health benefit plan as described by Subsection (a) of this
3-14 section.
3-15 Sec. 3. COVERAGE REQUIRED. (a) A health benefit plan that
3-16 provides maternity benefits, including benefits for childbirth,
3-17 must include coverage for the services of a lactation consultant
3-18 requested by the enrollee during pregnancy and for one year after
3-19 the date of delivery of the enrollee's child.
3-20 (b) Benefits required under this article may be made subject
3-21 to a deductible, copayment, or coinsurance requirement. A
3-22 deductible, copayment, or coinsurance required by the health
3-23 benefit plan for benefits under this article may not exceed the
3-24 deductible, copayment, or coinsurance required by the health
3-25 benefit plan for any other maternity benefit.
3-26 Sec. 4. RULES. The commissioner shall adopt rules as
3-27 necessary to administer this article.
4-1 SECTION 2. This Act takes effect September 1, 1999, and
4-2 applies only to a health benefit plan that is delivered, issued for
4-3 delivery, or renewed on or after January 1, 2000. A health benefit
4-4 plan delivered, issued for delivery, or renewed before January 1,
4-5 2000, is governed by the law as it existed immediately before the
4-6 effective date of this Act, and that law is continued in effect for
4-7 that purpose.
4-8 SECTION 3. The importance of this legislation and the
4-9 crowded condition of the calendars in both houses create an
4-10 emergency and an imperative public necessity that the
4-11 constitutional rule requiring bills to be read on three several
4-12 days in each house be suspended, and this rule is hereby suspended.