By: Harris S.B. No. 770
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to availability of health benefit plan coverage for
1-3 certain dependents of an enrollee.
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 21.53Y to read as follows:
1-7 Art. 21.53Y. AVAILABILITY OF COVERAGE FOR DEPENDENTS
1-8 Sec. 1. DEFINITIONS. In this article:
1-9 (1) "Child" means a natural or adopted child, a
1-10 stepchild, or a foster child.
1-11 (2) "Enrollee" means a person entitled to coverage
1-12 under a health benefit plan.
1-13 Sec. 2. APPLICABILITY OF ARTICLE. (a) This article applies
1-14 only to a health benefit plan that provides benefits for medical or
1-15 surgical expenses incurred as a result of a health condition,
1-16 accident, or sickness, including an individual, group, blanket, or
1-17 franchise insurance policy or insurance agreement, a group hospital
1-18 service contract, or an individual or group evidence of coverage or
1-19 similar coverage document that is offered by:
1-20 (1) an insurance company;
1-21 (2) a group hospital service corporation operating
1-22 under Chapter 20 of this code;
1-23 (3) a fraternal benefit society operating under
1-24 Chapter 10 of this code;
1-25 (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 health maintenance organization operating under
2-5 the Texas Health Maintenance Organization Act (Chapter 20A,
2-6 Vernon's Texas Insurance Code);
2-7 (7) a multiple employer welfare arrangement that holds
2-8 a certificate of authority under Article 3.95-2 of this code; or
2-9 (8) an approved nonprofit health corporation that
2-10 holds a certificate of authority under Article 21.52F of this code.
2-11 (b) This article applies to a small employer health benefit
2-12 plan written under Chapter 26 of this code.
2-13 (c) This article does not apply to:
2-14 (1) a plan that provides coverage:
2-15 (A) only for benefits for a specified disease or
2-16 for another limited benefit;
2-17 (B) only for accidental death or dismemberment;
2-18 (C) for wages or payments instead of wages for a
2-19 period during which an employee is absent from work because of
2-20 sickness or injury;
2-21 (D) as a supplement to a liability insurance
2-22 policy;
2-23 (E) for credit insurance;
2-24 (F) only for dental or vision care;
2-25 (G) only for hospital expenses; or
2-26 (H) only for indemnity for hospital confinement;
3-1 (2) a Medicare supplemental policy as defined by
3-2 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-3 as amended;
3-4 (3) a workers' compensation insurance policy;
3-5 (4) medical payment insurance coverage provided under
3-6 a motor vehicle insurance policy; or
3-7 (5) a long-term care insurance policy, including a
3-8 nursing home fixed indemnity policy, unless the commissioner
3-9 determines that the policy provides benefit coverage so
3-10 comprehensive that the policy is a health benefit plan as described
3-11 by Subsection (a) of this section.
3-12 Sec. 3. COVERAGE REQUIRED. A health benefit plan that
3-13 offers coverage for dependent children of an enrollee must make
3-14 dependent coverage available for a child of an enrollee who is:
3-15 (1) under 25 years of age;
3-16 (2) unmarried; and
3-17 (3) financially dependent on the parent.
3-18 SECTION 2. Subdivision (5), Section 2, Article 3.77,
3-19 Insurance Code, is amended to read as follows:
3-20 (5) "Dependent" means a resident spouse, an [or]
3-21 unmarried child under the age of 25 [18] years[, a child who is a
3-22 full-time student under the age of 23 years and] who is financially
3-23 dependent upon the parent, a child who is over 18 years of age and
3-24 for whom a person may be obligated to pay child support, or a child
3-25 of any age who is disabled and dependent upon the parent.
3-26 SECTION 3. Subdivision (8), Article 26.02, Insurance Code,
4-1 is amended to read as follows:
4-2 (8) "Dependent" means:
4-3 (A) a spouse;
4-4 (B) a newborn child;
4-5 (C) a child for whom coverage must be offered
4-6 under Article 21.53Y of this code [a child under the age of 19
4-7 years];
4-8 (D) [a child who is a full-time student under
4-9 the age of 23 years and who is financially dependent on the parent;]
4-10 [(E)] a child of any age who is medically
4-11 certified as disabled and dependent on the parent;
4-12 (E) [(F)] any person who must be covered under:
4-13 (i) Section 3D or 3E, Article 3.51-6, of
4-14 this code; or
4-15 (ii) Section 2(L), Chapter 397, Acts of
4-16 the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
4-17 Vernon's Texas Insurance Code); and
4-18 (F) [(G)] any other child included as an
4-19 eligible dependent under an employer's benefit plan.
4-20 SECTION 4. Article 21.24-2, Insurance Code, is repealed.
4-21 SECTION 5. This Act takes effect September 1, 2001, and
4-22 applies only to a health benefit plan delivered, issued for
4-23 delivery, or renewed on or after January 1, 2002. A health benefit
4-24 plan delivered, issued for delivery, or renewed before January 1,
4-25 2002, is governed by the law in effect immediately before the
4-26 effective date of this Act, and that law is continued in effect for
5-1 that purpose.