1-1     By:  Lucio, Madla, Barrientos                          S.B. No. 427
 1-2           (In the Senate - Filed January 26, 2001; January 29, 2001,
 1-3     read first time and referred to Committee on Business and Commerce;
 1-4     May 3, 2001, reported adversely, with favorable Committee
 1-5     Substitute by the following vote:  Yeas 5, Nays 1; May 3, 2001,
 1-6     sent to printer.)
 1-7     COMMITTEE SUBSTITUTE FOR S.B. No. 427                    By:  Lucio
 1-8                            A BILL TO BE ENTITLED
 1-9                                   AN ACT
1-10     relating to health benefit plan coverage for an enrollee with
1-11     autism and pervasive developmental disorders.
1-12           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-13           SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is
1-14     amended by adding Article 21.53X to read as follows:
1-15           Art. 21.53X.  INDIVIDUAL OR GROUP HEALTH BENEFIT PLAN
1-16     COVERAGE FOR ENROLLEE WITH AUTISM OR PERVASIVE DEVELOPMENTAL
1-17     DISORDER
1-18           Sec. 1.  DEFINITION.  In this article, "enrollee" means a
1-19     person entitled to coverage under a health benefit plan.
1-20           Sec. 2.  APPLICABILITY OF ARTICLE.  (a)  This article applies
1-21     only to a health benefit plan that provides benefits for medical or
1-22     surgical expenses incurred as a result of a health condition,
1-23     accident, or sickness, including an individual, group, blanket, or
1-24     franchise insurance policy or insurance agreement, a group hospital
1-25     service contract, or an individual or group evidence of coverage or
1-26     similar coverage document that is offered by:
1-27                 (1)  an insurance company;
1-28                 (2)  a group hospital service corporation operating
1-29     under Chapter 20 of this code;
1-30                 (3)  a fraternal benefit society operating under
1-31     Chapter 10 of this code;
1-32                 (4)  a stipulated premium insurance company operating
1-33     under Chapter 22 of this code;
1-34                 (5)  a reciprocal exchange operating under Chapter 19
1-35     of this code;
1-36                 (6)  a health maintenance organization operating under
1-37     the Texas Health Maintenance Organization Act (Chapter 20A,
1-38     Vernon's Texas Insurance Code);
1-39                 (7)  a multiple employer welfare arrangement that holds
1-40     a certificate of authority under Article 3.95-2 of this code; or
1-41                 (8)  an approved nonprofit health corporation that
1-42     holds a certificate of authority under Article 21.52F of this code.
1-43           (b)  Notwithstanding Section 172.014, Local Government Code,
1-44     or any other law, this article applies to health and accident
1-45     coverage provided by a risk pool created under Chapter 172, Local
1-46     Government Code.
1-47           (c)  This article does not apply to:
1-48                 (1)  a plan that provides coverage:
1-49                       (A)  only for benefits for a specified disease or
1-50     for another limited benefit;
1-51                       (B)  only for accidental death or dismemberment;
1-52                       (C)  for wages or payments in lieu of wages for a
1-53     period during which an employee is absent from work because of
1-54     sickness or injury;
1-55                       (D)  as a supplement to a liability insurance
1-56     policy;
1-57                       (E)  only for dental or vision care; or
1-58                       (F)  only for indemnity for hospital confinement;
1-59                 (2)  a small employer health benefit plan written under
1-60     Chapter 26 of this code;
1-61                 (3)  a Medicare supplemental policy as defined by
1-62     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
1-63     as amended;
1-64                 (4)  a workers' compensation insurance policy;
 2-1                 (5)  medical payment insurance coverage provided under
 2-2     a motor vehicle insurance policy; or
 2-3                 (6)  a long-term care insurance policy, including a
 2-4     nursing home fixed indemnity policy, unless the commissioner
 2-5     determines that the policy provides benefit coverage so
 2-6     comprehensive that the policy is a health benefit plan as described
 2-7     by Subsection (a) of this section.
 2-8           Sec. 3.  EXCLUSION OF COVERAGE AND DENIAL OF BENEFITS
 2-9     PROHIBITED.  In addition to providing any coverage required under
2-10     Article 3.51-14 of this code, a health benefit plan may not exclude
2-11     coverage or deny benefits for an enrollee for a particular
2-12     treatment, equipment, or therapy based on the enrollee's having
2-13     autism or a pervasive developmental disorder.
2-14           Sec. 4.  RULES.  The commissioner shall adopt rules as
2-15     necessary to administer this article.
2-16           SECTION 2.  This Act takes effect September 1, 2001, and
2-17     applies only to a health benefit plan delivered, issued for
2-18     delivery, or renewed on or after January 1, 2002.  A health benefit
2-19     plan delivered, issued for delivery, or renewed before January 1,
2-20     2002, is governed by the law as it existed immediately before the
2-21     effective date of this Act, and that law is continued in effect for
2-22     that purpose.
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