By Uher H.B. No. 1066
77R4901 PB-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefits coverage of certain 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, if the employee or
1-15 member provides at least 75 percent of the child's care.
1-16 SECTION 2. Section 2(A), Chapter 397, Acts of the 54th
1-17 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
1-18 Insurance Code), is amended to read as follows:
1-19 (A) No policy of accident and sickness insurance shall be
1-20 delivered or issued for delivery to any person in this state
1-21 unless:
1-22 (1) the entire money and other consideration therefor
1-23 are expressed therein or in the application, if it is made a part
1-24 of the policy; and
2-1 (2) the time at which the insurance takes effect and
2-2 terminates is expressed therein; and
2-3 (3) it purports to insure only one person, except that
2-4 a policy may insure, originally or by subsequent amendment, upon
2-5 the application of an adult member of a family who shall be deemed
2-6 the policy holder, any two or more eligible members of that family,
2-7 including:
2-8 (a) the spouse of the policy holder;
2-9 (b) a dependent child of the policy holder or
2-10 any child under a specified age that may not exceed 25 years of
2-11 age;
2-12 (c) [husband, wife, dependent children,
2-13 including] a dependent grandchild of the policy holder who is less
2-14 than 21 years old and living with and in the household of the
2-15 policy holder; provided that, for purposes of this paragraph, a
2-16 grandchild of a policy holder is a dependent of the policy holder
2-17 regardless of whether the policy holder treats the grandchild as a
2-18 dependent for federal income tax purposes, if the policy holder
2-19 provides at least 75 percent of the child's care;
2-20 (d) [or any children under a specified age which
2-21 shall not exceed twenty-five years,] a child the policy holder is
2-22 required to insure under a medical support order issued under
2-23 Chapter 154 [Section 14.061], Family Code, or enforceable by a
2-24 court in this state;[,] and
2-25 (e) any other person dependent upon the policy
2-26 holder; and
2-27 (4) the style, arrangement and over-all appearance of
3-1 the policy gives no undue prominence to any portion of the text,
3-2 and unless every printed portion of the text of the policy and of
3-3 any endorsements or attached papers (except copies of applications
3-4 and identification cards) are plainly printed in lightfaced type of
3-5 a style in general use, the size of which shall be uniform and not
3-6 less than ten-point with a lower-case unspaced alphabet length not
3-7 less than one hundred and twenty-point (the "text" shall include
3-8 all printed matter except the name and address of the insurer, name
3-9 or title of the policy, the brief description, if any, and captions
3-10 and subcaptions); and
3-11 (5) the exceptions and reductions of indemnity are set
3-12 forth in the policy and, except those which are set forth in
3-13 Section 3 of this Act, are printed, at the insurer's option, either
3-14 included with the benefit provision to which they apply, or under
3-15 an appropriate caption such as "Exceptions" or "Exceptions and
3-16 Reductions"; provided that if an exception or reduction
3-17 specifically applies only to a particular benefit of the policy, a
3-18 statement of such exception or reduction shall be included with the
3-19 benefit provision to which it applies; and
3-20 (6) each such form, including riders and endorsements,
3-21 shall be identified by a form number in the lower left-hand corner
3-22 of the first page thereof; and
3-23 (7) it contains no provision purporting to make any
3-24 portion of the charter, rules, constitution, or bylaws of the
3-25 insurer a part of the policy unless such portion is set forth in
3-26 full in the policy, except in the case of the incorporation of, or
3-27 reference to, a statement of rates or classification of risks, or
4-1 shortrate table filed with the Board; and
4-2 (8) it shall have printed thereon or attached thereto
4-3 a notice stating in substance that the person to whom the policy is
4-4 issued shall be permitted to return the policy within ten (10) days
4-5 of its delivery to such person and to have the premium paid
4-6 refunded if, after examination of the policy, such person is not
4-7 satisfied with it for any reason. If such person pursuant to such
4-8 notice, returns the policy to the insurer at its home or branch
4-9 office or to the agent through whom it was purchased, it shall be
4-10 void from the beginning and the parties shall be in the same
4-11 position as if no policy had been issued. This subdivision shall
4-12 not apply to single premium nonrenewable policies.
4-13 SECTION 3. Section 2(L), Chapter 397, Acts of the 54th
4-14 Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
4-15 Insurance Code), is amended to read as follows:
4-16 (L) An individual or group policy of accident and sickness
4-17 insurance that is delivered, issued for delivery, or renewed in
4-18 this state, including a policy issued by a company subject to
4-19 Chapter 20, Insurance Code, evidence of coverage issued by a health
4-20 maintenance organization subject to the Texas Health Maintenance
4-21 Organization Act (Chapter 20A, Vernon's Texas Insurance Code), and
4-22 a self-funded or self-insured welfare or benefit plan or program to
4-23 the extent that regulation of the plan or program is not preempted
4-24 by federal law that provides coverage for a child of the
4-25 policyholder, must provide coverage upon payment of a premium for:
4-26 (1) any children of the policyholder's child if those
4-27 children are dependents of the policyholder; provided that, for
5-1 purposes of this subdivision, a grandchild of a policyholder is a
5-2 dependent of the policyholder regardless of whether the
5-3 policyholder treats the grandchild as a dependent for federal
5-4 income tax purposes, if the policyholder provides at least 75
5-5 percent of the child's care; or
5-6 (2) [for] a child for whom the group member or insured
5-7 must provide medical support under an order issued under Chapter
5-8 154 [Section 14.061], Family Code, or enforceable by a court in
5-9 this state.
5-10 SECTION 4. Section 9(k), Texas Health Maintenance
5-11 Organization Act (Article 20A.09, Vernon's Texas Insurance Code)
5-12 (former Subsection (j)), as amended by Chapters 905 and 1026, Acts
5-13 of the 75th Legislature, Regular Session, 1997, is redesignated as
5-14 Section 9H, Texas Health Maintenance Organization Act (Chapter 20A,
5-15 Vernon's Texas Insurance Code), and amended to read as follows:
5-16 Sec. 9H. DEPENDENT GRANDCHILDREN. (a) [(k) (r)] A health
5-17 maintenance organization may provide benefits under a health care
5-18 plan to a dependent grandchild of an enrollee when the dependent
5-19 grandchild is less than 21 years old and living with and in the
5-20 household of the enrollee.
5-21 (b) For purposes of this section, a grandchild of an
5-22 enrollee is a dependent, regardless of whether the enrollee treats
5-23 the grandchild as a dependent for federal income tax purposes, if
5-24 the enrollee provides at least 75 percent of the child's care.
5-25 SECTION 5. This Act applies only to an insurance policy,
5-26 contract, or evidence of coverage delivered, issued for delivery,
5-27 or renewed on or after January 1, 2002. A policy, contract, or
6-1 evidence of coverage delivered, issued for delivery, or renewed
6-2 before January 1, 2002, is governed by the law as it existed
6-3 immediately before the effective date of this Act, and that law is
6-4 continued in effect for that purpose.
6-5 SECTION 6. This Act takes effect September 1, 2001.