1-1 By: Harris S.B. No. 770
1-2 (In the Senate - Filed February 19, 2001; February 20, 2001,
1-3 read first time and referred to Committee on Business and Commerce;
1-4 March 29, 2001, reported favorably by the following vote: Yeas 6,
1-5 Nays 0; March 29, 2001, sent to printer.)
1-6 A BILL TO BE ENTITLED
1-7 AN ACT
1-8 relating to availability of health benefit plan coverage for
1-9 certain dependents of an enrollee.
1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-12 amended by adding Article 21.53Y to read as follows:
1-13 Art. 21.53Y. AVAILABILITY OF COVERAGE FOR DEPENDENTS
1-14 Sec. 1. DEFINITIONS. In this article:
1-15 (1) "Child" means a natural or adopted child, a
1-16 stepchild, or a foster child.
1-17 (2) "Enrollee" means a person entitled to coverage
1-18 under a health benefit plan.
1-19 Sec. 2. APPLICABILITY OF ARTICLE. (a) This article applies
1-20 only to a health benefit plan that provides benefits for medical or
1-21 surgical expenses incurred as a result of a health condition,
1-22 accident, or sickness, including an individual, group, blanket, or
1-23 franchise insurance policy or insurance agreement, a group hospital
1-24 service contract, or an individual or group evidence of coverage or
1-25 similar coverage document that is offered by:
1-26 (1) an insurance company;
1-27 (2) a group hospital service corporation operating
1-28 under Chapter 20 of this code;
1-29 (3) a fraternal benefit society operating under
1-30 Chapter 10 of this code;
1-31 (4) a stipulated premium insurance company operating
1-32 under Chapter 22 of this code;
1-33 (5) a reciprocal exchange operating under Chapter 19
1-34 of this code;
1-35 (6) a health maintenance organization operating under
1-36 the Texas Health Maintenance Organization Act (Chapter 20A,
1-37 Vernon's Texas Insurance Code);
1-38 (7) a multiple employer welfare arrangement that holds
1-39 a certificate of authority under Article 3.95-2 of this code; or
1-40 (8) an approved nonprofit health corporation that
1-41 holds a certificate of authority under Article 21.52F of this code.
1-42 (b) This article applies to a small employer health benefit
1-43 plan written under Chapter 26 of this code.
1-44 (c) This article does not apply to:
1-45 (1) a plan that provides coverage:
1-46 (A) only for benefits for a specified disease or
1-47 for another limited benefit;
1-48 (B) only for accidental death or dismemberment;
1-49 (C) for wages or payments instead of wages for a
1-50 period during which an employee is absent from work because of
1-51 sickness or injury;
1-52 (D) as a supplement to a liability insurance
1-53 policy;
1-54 (E) for credit insurance;
1-55 (F) only for dental or vision care;
1-56 (G) only for hospital expenses; or
1-57 (H) only for indemnity for hospital confinement;
1-58 (2) a Medicare supplemental policy as defined by
1-59 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
1-60 as amended;
1-61 (3) a workers' compensation insurance policy;
1-62 (4) medical payment insurance coverage provided under
1-63 a motor vehicle insurance policy; or
1-64 (5) a long-term care insurance policy, including a
2-1 nursing home fixed indemnity policy, unless the commissioner
2-2 determines that the policy provides benefit coverage so
2-3 comprehensive that the policy is a health benefit plan as described
2-4 by Subsection (a) of this section.
2-5 Sec. 3. COVERAGE REQUIRED. A health benefit plan that
2-6 offers coverage for dependent children of an enrollee must make
2-7 dependent coverage available for a child of an enrollee who is:
2-8 (1) under 25 years of age;
2-9 (2) unmarried; and
2-10 (3) financially dependent on the parent.
2-11 SECTION 2. Subdivision (5), Section 2, Article 3.77,
2-12 Insurance Code, is amended to read as follows:
2-13 (5) "Dependent" means a resident spouse, an [or]
2-14 unmarried child under the age of 25 [18] years[, a child who is a
2-15 full-time student under the age of 23 years and] who is financially
2-16 dependent upon the parent, a child who is over 18 years of age and
2-17 for whom a person may be obligated to pay child support, or a child
2-18 of any age who is disabled and dependent upon the parent.
2-19 SECTION 3. Subdivision (8), Article 26.02, Insurance Code,
2-20 is amended to read as follows:
2-21 (8) "Dependent" means:
2-22 (A) a spouse;
2-23 (B) a newborn child;
2-24 (C) a child for whom coverage must be offered
2-25 under Article 21.53Y of this code [a child under the age of 19
2-26 years];
2-27 (D) [a child who is a full-time student under
2-28 the age of 23 years and who is financially dependent on the parent;]
2-29 [(E)] a child of any age who is medically
2-30 certified as disabled and dependent on the parent;
2-31 (E) [(F)] any person who must be covered under:
2-32 (i) Section 3D or 3E, Article 3.51-6, of
2-33 this code; or
2-34 (ii) Section 2(L), Chapter 397, Acts of
2-35 the 54th Legislature, Regular Session, 1955 (Article 3.70-2,
2-36 Vernon's Texas Insurance Code); and
2-37 (F) [(G)] any other child included as an
2-38 eligible dependent under an employer's benefit plan.
2-39 SECTION 4. Article 21.24-2, Insurance Code, is repealed.
2-40 SECTION 5. This Act takes effect September 1, 2001, and
2-41 applies only to a health benefit plan delivered, issued for
2-42 delivery, or renewed on or after January 1, 2002. A health benefit
2-43 plan delivered, issued for delivery, or renewed before January 1,
2-44 2002, is governed by the law in effect immediately before the
2-45 effective date of this Act, and that law is continued in effect for
2-46 that purpose.
2-47 * * * * *