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.