77R16720 AJA-D
By Lucio, et al. S.B. No. 427
Substitute the following for S.B. No. 427:
By Smithee C.S.S.B. No. 427
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to health benefit plan coverage for an enrollee with
1-3 autism and pervasive developmental disorders.
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 21.53X to read as follows:
1-7 Art. 21.53X. INDIVIDUAL OR GROUP HEALTH BENEFIT PLAN
1-8 COVERAGE FOR ENROLLEE WITH AUTISM OR PERVASIVE DEVELOPMENTAL
1-9 DISORDER
1-10 Sec. 1. DEFINITION. In this article, "enrollee" means a
1-11 person entitled to coverage under a health benefit plan.
1-12 Sec. 2. APPLICABILITY OF ARTICLE. (a) This article applies
1-13 only to a health benefit plan that provides benefits for medical or
1-14 surgical expenses incurred as a result of a health condition,
1-15 accident, or sickness, including an individual, group, blanket, or
1-16 franchise insurance policy or insurance agreement, a group hospital
1-17 service contract, or an individual or group evidence of coverage or
1-18 similar coverage document that is offered by:
1-19 (1) an insurance company;
1-20 (2) a group hospital service corporation operating
1-21 under Chapter 20 of this code;
1-22 (3) a fraternal benefit society operating under
1-23 Chapter 10 of this code;
1-24 (4) a stipulated premium insurance company operating
2-1 under Chapter 22 of this code;
2-2 (5) a reciprocal exchange operating under Chapter 19
2-3 of this code;
2-4 (6) a Lloyd's plan operating under Chapter 18 of this
2-5 code;
2-6 (7) a health maintenance organization operating under
2-7 the Texas Health Maintenance Organization Act (Chapter 20A,
2-8 Vernon's Texas Insurance Code);
2-9 (8) a multiple employer welfare arrangement that holds
2-10 a certificate of authority under Article 3.95-2 of this code; or
2-11 (9) an approved nonprofit health corporation that
2-12 holds a certificate of authority under Article 21.52F of this code.
2-13 (b) Notwithstanding Section 172.014, Local Government Code,
2-14 or any other law, this article applies to health and accident
2-15 coverage provided by a risk pool created under Chapter 172, Local
2-16 Government Code.
2-17 (c) This article does not apply to:
2-18 (1) a plan that provides coverage:
2-19 (A) only for benefits for a specified disease or
2-20 for another limited benefit, other than a plan that provides
2-21 benefits for mental health or similar services;
2-22 (B) only for accidental death or dismemberment;
2-23 (C) for wages or payments in lieu of wages for a
2-24 period during which an employee is absent from work because of
2-25 sickness or injury;
2-26 (D) as a supplement to a liability insurance
2-27 policy;
3-1 (E) only for dental or vision care; or
3-2 (F) only for indemnity for hospital confinement;
3-3 (2) a small employer health benefit plan written under
3-4 Chapter 26 of this code;
3-5 (3) a Medicare supplemental policy as defined by
3-6 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-7 as amended;
3-8 (4) a workers' compensation insurance policy;
3-9 (5) medical payment insurance coverage provided under
3-10 a motor vehicle insurance policy; or
3-11 (6) a long-term care insurance policy, including a
3-12 nursing home fixed indemnity policy, unless the commissioner
3-13 determines that the policy provides benefit coverage so
3-14 comprehensive that the policy is a health benefit plan as described
3-15 by Subsection (a) of this section.
3-16 Sec. 3. EXCLUSION OF COVERAGE AND DENIAL OF BENEFITS
3-17 PROHIBITED. A health benefit plan may not exclude coverage or deny
3-18 benefits otherwise available to an enrollee for treatment,
3-19 equipment, or therapy based on the enrollee's having autism or a
3-20 pervasive developmental disorder.
3-21 Sec. 4. RULES. The commissioner shall adopt rules as
3-22 necessary to administer this article.
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 as it existed immediately before the
4-1 effective date of this Act, and that law is continued in effect for
4-2 that purpose.