By Burnam H.B. No. 1676 77R5105 AJA-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to health benefit plan coverage for survivors of traumatic 1-3 brain injury. 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 21.53Q to read as follows: 1-7 Art. 21.53Q. HEALTH BENEFIT PLAN COVERAGE FOR SURVIVORS OF 1-8 TRAUMATIC BRAIN INJURY 1-9 Sec. 1. APPLICABILITY OF ARTICLE. (a) This article 1-10 applies only to a health benefit plan that provides benefits for 1-11 medical or surgical expenses incurred as a result of a health 1-12 condition, accident, or sickness, including an individual, group, 1-13 blanket, or franchise insurance policy or insurance agreement, a 1-14 group hospital service contract, or an individual or group evidence 1-15 of coverage or similar coverage document that is offered by: 1-16 (1) an insurance company; 1-17 (2) a group hospital service corporation operating 1-18 under Chapter 20 of this code; 1-19 (3) a fraternal benefit society operating under 1-20 Chapter 10 of this code; 1-21 (4) a stipulated premium insurance company operating 1-22 under Chapter 22 of this code; 1-23 (5) a reciprocal exchange operating under Chapter 19 1-24 of this code; 2-1 (6) a health maintenance organization operating under 2-2 the Texas Health Maintenance Organization Act (Chapter 20A, 2-3 Vernon's Texas Insurance Code); 2-4 (7) a multiple employer welfare arrangement that holds 2-5 a certificate of authority under Article 3.95-2 of this code; or 2-6 (8) an approved nonprofit health corporation that 2-7 holds a certificate of authority under Article 21.52F of this code. 2-8 (b) This article applies to a small employer health benefit 2-9 plan written under Chapter 26 of this code. 2-10 (c) This article does not apply to: 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. LIMITATION OR EXCLUSION OF COVERAGE PROHIBITED. (a) 3-9 A health benefit plan may not limit or exclude coverage for 3-10 cognitive therapy, neuropsychological testing or treatment, or 3-11 community reintegration activities necessary as a result of a 3-12 traumatic brain injury. 3-13 (b) The commissioner shall adopt rules as necessary to 3-14 implement this section. 3-15 Sec. 3. TRAINING FOR PRECERTIFICATION PERSONNEL REQUIRED. 3-16 The commissioner by rule shall require the issuer of a health 3-17 benefit plan to provide to personnel responsible for 3-18 precertification of coverage under the plan training designed to 3-19 prevent precertification of coverage required under this article 3-20 from being wrongly denied based on a determination that the 3-21 benefits for which precertification of coverage is requested are 3-22 psychiatric benefits rather than medical benefits. 3-23 SECTION 2. This Act takes effect September 1, 2001, and 3-24 applies only to a health benefit plan delivered, issued for 3-25 delivery, or renewed on or after January 1, 2002. A health benefit 3-26 plan delivered, issued for delivery, or renewed before January 1, 3-27 2002, is governed by the law in effect immediately before the 4-1 effective date of this Act, and that law is continued in effect for 4-2 that purpose.