By Deshotel H.B. No. 1929
77R5846 DLF-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to prescription drug benefits under certain health benefit
1-3 plans.
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 21.52B-1 to read as follows:
1-7 Art. 21.52B-1. DELIVERY OF PRESCRIPTION DRUGS BY MAIL ORDER;
1-8 ALTERNATIVE REQUIRED
1-9 Sec. 1. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this
1-10 article, "health benefit plan" means a plan that provides benefits
1-11 for 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) "Health benefit plan" does not include:
2-9 (1) a plan that provides coverage only:
2-10 (A) for benefits for a specified disease or for
2-11 another limited benefit other than for cancer;
2-12 (B) for accidental death or dismemberment;
2-13 (C) for wages or payments in lieu of wages for a
2-14 period during which an employee is absent from work because of
2-15 sickness or injury;
2-16 (D) as a supplement to a liability insurance
2-17 policy;
2-18 (E) for credit insurance;
2-19 (F) for dental or vision care; or
2-20 (G) for indemnity for hospital confinement;
2-21 (2) a small employer health benefit plan offered in
2-22 accordance with Chapter 26 of this code;
2-23 (3) a Medicare supplemental policy as defined by
2-24 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
2-25 as amended;
2-26 (4) a workers' compensation insurance policy;
2-27 (5) medical payment insurance coverage provided under
3-1 a motor vehicle insurance policy; or
3-2 (6) a long-term care insurance policy, including a
3-3 nursing home fixed indemnity policy, unless the commissioner
3-4 determines that the policy provides benefit coverage so
3-5 comprehensive that the policy is a health benefit plan as described
3-6 by Subsection (a) of this section.
3-7 Sec. 2. DELIVERY BY MAIL ORDER. For purposes of this
3-8 article, a prescription drug is obtained by mail order if it is
3-9 delivered to an enrollee by the United States Postal Service or a
3-10 commercial delivery service and not provided to the enrollee in an
3-11 over-the-counter transaction in a pharmacy.
3-12 Sec. 3. PROHIBITION. A health benefit plan that provides
3-13 benefits for prescription drugs may not condition the benefits by
3-14 requiring enrollees to obtain the drugs by mail order.
3-15 Sec. 4. AVAILABILITY OF PRESCRIPTION DRUGS. (a) A health
3-16 benefit plan that provides benefits for prescription drugs must
3-17 provide the benefit for a prescription drug that is not obtained by
3-18 mail order:
3-19 (1) for each prescription drug that may be obtained by
3-20 mail order under the plan; and
3-21 (2) under the same circumstances as a prescription
3-22 drug that may be obtained by mail order under the plan.
3-23 (b) The health benefit plan may not impose any deductible,
3-24 copayment, coinsurance, or other cost-sharing obligation for a
3-25 prescription drug that is not obtained by mail order unless a
3-26 similar cost-sharing obligation is imposed for a prescription drug
3-27 obtained by mail order under the plan.
4-1 (c) Except as provided by Subsection (d) of this section,
4-2 the health benefit plan must provide the same dollar amount of
4-3 payment for a prescription drug that is not obtained by mail order
4-4 as is provided for a prescription drug obtained by mail order under
4-5 the plan.
4-6 (d) A health benefit plan that does not comply with
4-7 Subsection (c) of this section may not impose any deductible,
4-8 copayment, coinsurance, or other cost-sharing obligation for a
4-9 prescription drug that is not obtained by mail order that exceeds
4-10 the amount of the cost-sharing obligation imposed for a
4-11 prescription drug obtained by mail order under the plan.
4-12 Sec. 5. UNFAIR ACT IN THE BUSINESS OF INSURANCE. An issuer
4-13 of a health benefit plan that violates this article commits an
4-14 unfair act in the business of insurance for purposes of Article
4-15 21.21 of this code.
4-16 SECTION 2. This Act takes effect September 1, 2001, and
4-17 applies only to a health benefit plan that is delivered, issued for
4-18 delivery, or renewed on or after January 1, 2002. A plan that is
4-19 delivered, issued for delivery, or renewed before January 1, 2002,
4-20 is governed by the law as it existed immediately before the
4-21 effective date of this Act, and that law is continued in effect for
4-22 that purpose.