By Coleman H.B. No. 760
77R3376 AJA-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefit plan coverage for certain physical
1-3 injuries that are self-inflicted by a minor.
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 21.53P to read as follows:
1-7 Art. 21.53P. COVERAGE FOR CERTAIN SELF-INFLICTED PHYSICAL
1-8 INJURIES BY MINORS
1-9 Sec. 1. DEFINITIONS. In this article:
1-10 (1) "Enrollee" means an individual entitled to
1-11 coverage under a health benefit plan.
1-12 (2) "Serious mental illness" means:
1-13 (A) the following psychiatric illnesses as
1-14 defined by the American Psychiatric Association's Diagnostic and
1-15 Statistical Manual designated DSM-IV:
1-16 (i) schizophrenia;
1-17 (ii) paranoid and other psychotic
1-18 disorders;
1-19 (iii) bipolar disorders (hypomanic, manic,
1-20 depressive, and mixed);
1-21 (iv) major depressive disorders (single
1-22 episode or recurrent);
1-23 (v) schizo-affective disorders (bipolar or
1-24 depressive);
2-1 (vi) pervasive developmental disorders;
2-2 (vii) obsessive-compulsive disorders; and
2-3 (viii) depression; or
2-4 (B) a diagnosable behavioral or emotional
2-5 disorder or a neuropsychiatric condition:
2-6 (i) that results in a serious disability
2-7 requiring sustained treatment interventions;
2-8 (ii) that is of sufficient duration to
2-9 meet diagnostic criteria specified in the American Psychiatric
2-10 Association's Diagnostic and Statistical Manual designated DSM-IV;
2-11 and
2-12 (iii) with respect to which the person
2-13 exhibits impairment in thought, perception, affect, or behavior
2-14 that substantially interferes with or limits the person's role or
2-15 functioning in the person's community, school, family, or peer
2-16 group.
2-17 Sec. 2. APPLICABILITY. (a) This article applies only to a
2-18 health benefit plan that provides benefits for medical or surgical
2-19 expenses incurred as a result of a health condition, accident, or
2-20 sickness, including an individual, group, blanket, or franchise
2-21 insurance policy or insurance agreement, a group hospital service
2-22 contract, or an individual or group evidence of coverage or similar
2-23 coverage document that is offered by:
2-24 (1) an insurance company;
2-25 (2) a group hospital service corporation operating
2-26 under Chapter 20 of this code;
2-27 (3) a fraternal benefit society operating under
3-1 Chapter 10 of this code;
3-2 (4) a stipulated premium insurance company operating
3-3 under Chapter 22 of this code;
3-4 (5) a reciprocal exchange operating under Chapter 19
3-5 of this code;
3-6 (6) a health maintenance organization operating under
3-7 the Texas Health Maintenance Organization Act (Chapter 20A,
3-8 Vernon's Texas Insurance Code);
3-9 (7) a multiple employer welfare arrangement that holds
3-10 a certificate of authority under Article 3.95-2 of this code;
3-11 (8) an approved nonprofit health corporation that
3-12 holds a certificate of authority under Article 21.52F of this code;
3-13 (9) an agency of the state under:
3-14 (A) the Texas Employees Uniform Group Insurance
3-15 Benefits Act (Article 3.50-2, Vernon's Texas Insurance Code);
3-16 (B) the Texas State College and University
3-17 Employees Uniform Insurance Benefits Act (Article 3.50-3, Vernon's
3-18 Texas Insurance Code); or
3-19 (C) Article 3.50-4 of this code;
3-20 (10) a political subdivision under Chapter 172, Local
3-21 Government Code; or
3-22 (11) a school district in accordance with Section
3-23 22.004, Education Code.
3-24 (b) This article does not apply to:
3-25 (1) a plan that provides coverage:
3-26 (A) for wages or payments in lieu of wages for a
3-27 period during which an employee is absent from work because of
4-1 sickness or injury;
4-2 (B) as a supplement to a liability insurance
4-3 policy;
4-4 (C) for credit insurance;
4-5 (D) only for dental or vision care;
4-6 (E) only for hospital expenses; or
4-7 (F) only for indemnity for hospital confinement;
4-8 (2) a small employer health benefit plan written under
4-9 Chapter 26 of this code, except when an independent school district
4-10 elects to participate in a small employer market in accordance with
4-11 Article 26.036 of this code;
4-12 (3) a Medicare supplemental policy as defined by
4-13 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
4-14 as amended;
4-15 (4) workers' compensation insurance policy;
4-16 (5) medical payment insurance coverage provided under
4-17 a motor vehicle insurance policy; or
4-18 (6) a long-term care policy, including a nursing home
4-19 fixed indemnity policy, unless the commissioner determines that the
4-20 policy provides benefit coverage so comprehensive that the policy
4-21 is a health benefit plan as described by Subsection (a) of this
4-22 section.
4-23 Sec. 3. COVERAGE REQUIRED. Regardless of whether a health
4-24 benefit plan provides mental health coverage, a health benefit plan
4-25 must provide coverage for an enrollee, from birth through the date
4-26 the enrollee is 18 years of age, for a physical injury to the
4-27 enrollee that is self-inflicted:
5-1 (1) in an attempt to commit suicide, regardless of:
5-2 (A) the state of mental health of the enrollee;
5-3 or
5-4 (B) whether the injury results in the death of
5-5 the enrollee; or
5-6 (2) by an enrollee with a serious mental illness.
5-7 Sec. 4. DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS.
5-8 The benefits required under this article may not be made subject to
5-9 a deductible, coinsurance, or copayment requirement that exceeds
5-10 the deductible, coinsurance, or copayment requirements applicable
5-11 to other physical injury benefits provided under the health benefit
5-12 plan.
5-13 Sec. 5. RULES. The commissioner shall adopt rules as
5-14 necessary to administer this article.
5-15 SECTION 2. This Act takes effect September 1, 2001, and
5-16 applies only to a health benefit plan that is delivered, issued for
5-17 delivery, or renewed on or after January 1, 2002. A health benefit
5-18 plan that is delivered, issued for delivery, or renewed before
5-19 January 1, 2002, is governed by the law as it existed immediately
5-20 before the effective date of this Act, and that law is continued in
5-21 effect for that purpose.