By Lewis of Tarrant H.B. No. 329
77R1024 AJA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage for maternity benefits under 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 21.53H to read as follows:
1-7 Art. 21.53H. COVERAGE FOR MATERNITY BENEFITS
1-8 Sec. 1. APPLICABILITY OF ARTICLE. (a) This article
1-9 applies only to a health benefit plan that provides benefits for
1-10 medical or surgical expenses incurred as a result of a health
1-11 condition, accident, or sickness, including an individual, group,
1-12 blanket, or franchise insurance policy or insurance agreement, a
1-13 group hospital service contract, or an individual or group evidence
1-14 of coverage or similar coverage document that is offered by:
1-15 (1) an insurance company;
1-16 (2) a group hospital service corporation operating
1-17 under Chapter 20 of this code;
1-18 (3) a fraternal benefit society operating under
1-19 Chapter 10 of this code;
1-20 (4) a stipulated premium insurance company operating
1-21 under Chapter 22 of this code;
1-22 (5) a reciprocal exchange operating under Chapter 19
1-23 of this code;
1-24 (6) a health maintenance organization operating under
2-1 the Texas Health Maintenance Organization Act (Chapter 20A,
2-2 Vernon's Texas Insurance Code);
2-3 (7) a multiple employer welfare arrangement that holds
2-4 a certificate of authority under Article 3.95-2 of this code;
2-5 (8) an approved nonprofit health corporation that
2-6 holds a certificate of authority under Article 21.52F of this code;
2-7 or
2-8 (9) a health benefit plan written under Chapter 26 of
2-9 this code.
2-10 (b) "Health benefit plan" does not include:
2-11 (1) a plan that provides coverage:
2-12 (A) only for benefits for a specified disease or
2-13 for another limited benefit;
2-14 (B) only for accidental death or dismemberment;
2-15 (C) for wages or payments in lieu of wages for a
2-16 period during which an employee is absent from work because of
2-17 sickness or injury;
2-18 (D) as a supplement to a liability insurance
2-19 policy;
2-20 (E) for credit insurance;
2-21 (F) only for dental or vision care;
2-22 (G) only for hospital expenses; or
2-23 (H) only for indemnity for hospital confinement;
2-24 (2) a Medicare supplemental policy as defined by
2-25 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
2-26 as amended;
2-27 (3) a workers' compensation insurance policy;
3-1 (4) medical payment insurance coverage provided under
3-2 a motor vehicle insurance policy; or
3-3 (5) a long-term care insurance policy, including a
3-4 nursing home fixed indemnity policy, unless the commissioner
3-5 determines that the policy provides benefit coverage so
3-6 comprehensive that the policy is a health benefit plan as described
3-7 by Subsection (a) of this section.
3-8 Sec. 2. COVERAGE REQUIRED. (a) A health benefit plan must
3-9 provide a woman who is entitled to benefits under the plan with
3-10 benefits for medically necessary expenses incurred as a result of
3-11 pregnancy or childbirth, regardless of whether the woman has
3-12 preexisting risk factors related to pregnancy or childbirth.
3-13 (b) The benefits described by this section may be subject to
3-14 annual deductibles, copayments, and coinsurance that are consistent
3-15 with annual deductibles, copayments, and coinsurance required for
3-16 other benefits under the plan.
3-17 (c) The benefits required by this subchapter may not be
3-18 subject to dollar limitations other than the health benefit plan's
3-19 lifetime maximum benefits.
3-20 Sec. 3. RULES. The commissioner may adopt rules as
3-21 necessary to implement this article.
3-22 SECTION 2. This Act takes effect September 1, 2001, and
3-23 applies only to a health benefit plan delivered, issued for
3-24 delivery, or renewed on or after January 1, 2002. A health benefit
3-25 plan delivered, issued for delivery, or renewed before January 1,
3-26 2002, is governed by the law as it existed immediately before the
3-27 effective date of this Act, and that law is continued in effect for
4-1 that purpose.