By Uher H.B. No. 1066
77R9016 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefits coverage of grandchildren.
1-3 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-4 SECTION 1. Section 1(b), Article 3.51-6, Insurance Code, is
1-5 amended to read as follows:
1-6 (b) The spouse and dependents of employees or members,
1-7 including a dependent grandchild of an employee or member who is
1-8 less than 21 years old and living with and in the household of the
1-9 employee or member, referred to in Subdivisions (a)(1) through
1-10 (a)(6) of this section may be included within the coverage provided
1-11 in a group policy. For purposes of this subsection, a grandchild
1-12 of an employee or member is a dependent of the employee or member,
1-13 regardless of whether the employee or member treats the grandchild
1-14 as a dependent for federal income tax purposes.
1-15 SECTION 2. Section 2(A), Chapter 397, Acts of the 54th
1-16 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
1-17 Insurance Code), is amended to read as follows:
1-18 (A) No policy of accident and sickness insurance shall be
1-19 delivered or issued for delivery to any person in this state
1-20 unless:
1-21 (1) the entire money and other consideration therefor
1-22 are expressed therein or in the application, if it is made a part
1-23 of the policy; and
1-24 (2) the time at which the insurance takes effect and
2-1 terminates is expressed therein; and
2-2 (3) it purports to insure only one person, except that
2-3 a policy may insure, originally or by subsequent amendment, upon
2-4 the application of an adult member of a family who shall be deemed
2-5 the policy holder, any two or more eligible members of that family,
2-6 including:
2-7 (a) the spouse of the policy holder;
2-8 (b) a dependent child of the policy holder or
2-9 any child under a specified age that may not exceed 25 years of
2-10 age;
2-11 (c) [husband, wife, dependent children,
2-12 including] a dependent grandchild of the policy holder who is less
2-13 than 21 years old and living with and in the household of the
2-14 policy holder; provided that, for purposes of this paragraph, a
2-15 grandchild of a policy holder is a dependent of the policy holder
2-16 regardless of whether the policy holder treats the grandchild as a
2-17 dependent for federal income tax purposes;
2-18 (d) [or any children under a specified age which
2-19 shall not exceed twenty-five years,] a child the policy holder is
2-20 required to insure under a medical support order issued under
2-21 Chapter 154 [Section 14.061], Family Code, or enforceable by a
2-22 court in this state;[,] and
2-23 (e) any other person dependent upon the policy
2-24 holder; and
2-25 (4) the style, arrangement and over-all appearance of
2-26 the policy gives no undue prominence to any portion of the text,
2-27 and unless every printed portion of the text of the policy and of
3-1 any endorsements or attached papers (except copies of applications
3-2 and identification cards) are plainly printed in lightfaced type of
3-3 a style in general use, the size of which shall be uniform and not
3-4 less than ten-point with a lower-case unspaced alphabet length not
3-5 less than one hundred and twenty-point (the "text" shall include
3-6 all printed matter except the name and address of the insurer, name
3-7 or title of the policy, the brief description, if any, and captions
3-8 and subcaptions); and
3-9 (5) the exceptions and reductions of indemnity are set
3-10 forth in the policy and, except those which are set forth in
3-11 Section 3 of this Act, are printed, at the insurer's option, either
3-12 included with the benefit provision to which they apply, or under
3-13 an appropriate caption such as "Exceptions" or "Exceptions and
3-14 Reductions"; provided that if an exception or reduction
3-15 specifically applies only to a particular benefit of the policy, a
3-16 statement of such exception or reduction shall be included with the
3-17 benefit provision to which it applies; and
3-18 (6) each such form, including riders and endorsements,
3-19 shall be identified by a form number in the lower left-hand corner
3-20 of the first page thereof; and
3-21 (7) it contains no provision purporting to make any
3-22 portion of the charter, rules, constitution, or bylaws of the
3-23 insurer a part of the policy unless such portion is set forth in
3-24 full in the policy, except in the case of the incorporation of, or
3-25 reference to, a statement of rates or classification of risks, or
3-26 shortrate table filed with the Board; and
3-27 (8) it shall have printed thereon or attached thereto
4-1 a notice stating in substance that the person to whom the policy is
4-2 issued shall be permitted to return the policy within ten (10) days
4-3 of its delivery to such person and to have the premium paid
4-4 refunded if, after examination of the policy, such person is not
4-5 satisfied with it for any reason. If such person pursuant to such
4-6 notice, returns the policy to the insurer at its home or branch
4-7 office or to the agent through whom it was purchased, it shall be
4-8 void from the beginning and the parties shall be in the same
4-9 position as if no policy had been issued. This subdivision shall
4-10 not apply to single premium nonrenewable policies.
4-11 SECTION 3. Section 2(L), Chapter 397, Acts of the 54th
4-12 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
4-13 Insurance Code), is amended to read as follows:
4-14 (L) An individual or group policy of accident and sickness
4-15 insurance that is delivered, issued for delivery, or renewed in
4-16 this state, including a policy issued by a company subject to
4-17 Chapter 20, Insurance Code, evidence of coverage issued by a health
4-18 maintenance organization subject to the Texas Health Maintenance
4-19 Organization Act (Chapter 20A, Vernon's Texas Insurance Code), and
4-20 a self-funded or self-insured welfare or benefit plan or program to
4-21 the extent that regulation of the plan or program is not preempted
4-22 by federal law that provides coverage for a child of the
4-23 policyholder, must provide coverage upon payment of a premium for:
4-24 (1) any children of the policyholder's child if those
4-25 children are dependents of the policyholder; provided that, for
4-26 purposes of this subdivision, a grandchild of a policyholder is a
4-27 dependent of the policyholder regardless of whether the
5-1 policyholder treats the grandchild as a dependent for federal
5-2 income tax purposes; or
5-3 (2) [for] a child for whom the group member or insured
5-4 must provide medical support under an order issued under Chapter
5-5 154 [Section 14.061], Family Code, or enforceable by a court in
5-6 this state.
5-7 SECTION 4. Section 9(k), Texas Health Maintenance
5-8 Organization Act (Article 20A.09, Vernon's Texas Insurance Code)
5-9 (former Subsection (j)), as amended by Chapters 905 and 1026, Acts
5-10 of the 75th Legislature, Regular Session, 1997, is redesignated as
5-11 Section 9H, Texas Health Maintenance Organization Act (Chapter 20A,
5-12 Vernon's Texas Insurance Code), and amended to read as follows:
5-13 Sec. 9H. DEPENDENT GRANDCHILDREN. (a) [(k) (r)] A health
5-14 maintenance organization may provide benefits under a health care
5-15 plan to a dependent grandchild of an enrollee when the dependent
5-16 grandchild is less than 21 years old and living with and in the
5-17 household of the enrollee.
5-18 (b) For purposes of this section, a grandchild of an
5-19 enrollee is a dependent, regardless of whether the enrollee treats
5-20 the grandchild as a dependent for federal income tax purposes.
5-21 SECTION 5. This Act applies only to an insurance policy,
5-22 contract, or evidence of coverage delivered, issued for delivery,
5-23 or renewed on or after January 1, 2002. A policy, contract, or
5-24 evidence of coverage delivered, issued for delivery, or renewed
5-25 before January 1, 2002, is governed by the law as it existed
5-26 immediately before the effective date of this Act, and that law is
5-27 continued in effect for that purpose.
6-1 SECTION 6. This Act takes effect September 1, 2001.