78R3344 AKH-D
By: Coleman H.B. No. 690
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for certain physical
injuries that are self-inflicted by a minor.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
amended by adding Article 21.53P to read as follows:
Art. 21.53P. COVERAGE FOR CERTAIN SELF-INFLICTED PHYSICAL
INJURIES BY MINORS
Sec. 1. DEFINITIONS. In this article:
(1) "Enrollee" means an individual entitled to
coverage under a health benefit plan.
(2) "Serious mental illness" means:
(A) the following psychiatric illnesses as
described by the American Psychiatric Association's Diagnostic and
Statistical Manual designated DSM-IV-TR:
(i) schizophrenia;
(ii) paranoid and other psychotic
disorders;
(iii) bipolar disorders (hypomanic, manic,
depressive, and mixed);
(iv) major depressive disorders (single
episode or recurrent);
(v) schizo-affective disorders (bipolar or
depressive);
(vi) pervasive developmental disorders;
(vii) obsessive-compulsive disorders; and
(viii) depression; or
(B) a diagnosable behavioral or emotional
disorder or a neuropsychiatric condition:
(i) that results in a serious disability
requiring sustained treatment interventions;
(ii) that is of sufficient duration to meet
diagnostic criteria specified in the American Psychiatric
Association's Diagnostic and Statistical Manual designated
DSM-IV-TR; and
(iii) with respect to which the person
exhibits impairment in thought, perception, affect, or behavior
that substantially interferes with or limits the person's role or
functioning in the person's community, school, family, or peer
group.
Sec. 2. APPLICABILITY. (a) This article applies only to a
health benefit plan that provides benefits for medical or surgical
expenses incurred as a result of a health condition, accident, or
sickness, including an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or an individual or group evidence of coverage or similar
coverage document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842 of this code;
(3) a fraternal benefit society operating under
Chapter 885 of this code;
(4) a stipulated premium insurance company operating
under Chapter 884 of this code;
(5) an exchange operating under Chapter 942 of this
code;
(6) a health maintenance organization operating under
Chapter 843 of this code;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846 of this code;
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844 of this code;
(9) an agency of the state under Chapter 1551, 1575, or
1601 of this code;
(10) a political subdivision under Chapter 172, Local
Government Code; or
(11) a school district in accordance with Section
22.004, Education Code.
(b) This article does not apply to:
(1) a plan that provides coverage:
(A) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(B) as a supplement to a liability insurance
policy;
(C) for credit insurance;
(D) only for dental or vision care;
(E) only for hospital expenses; or
(F) only for indemnity for hospital confinement;
(2) a small employer health benefit plan written under
Chapter 26 of this code, except when an independent school district
elects to participate in a small employer market in accordance with
Article 26.036 of this code;
(3) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
as amended;
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(6) a long-term care policy, including a nursing home
fixed indemnity policy, unless the commissioner determines that the
policy provides benefit coverage so comprehensive that the policy
is a health benefit plan as described by Subsection (a) of this
section.
Sec. 3. COVERAGE REQUIRED. Regardless of whether a health
benefit plan provides mental health coverage, a health benefit plan
must provide coverage for an enrollee, from birth through the date
the enrollee is 18 years of age, for a physical injury to the
enrollee that is self-inflicted:
(1) in an attempt to commit suicide, regardless of:
(A) the state of mental health of the enrollee;
or
(B) whether the injury results in the death of
the enrollee; or
(2) by an enrollee with a serious mental illness.
Sec. 4. DEDUCTIBLE, COINSURANCE, AND COPAYMENT
REQUIREMENTS. The benefits required under this article may not be
made subject to a deductible, coinsurance, or copayment requirement
that exceeds the deductible, coinsurance, or copayment
requirements applicable to other physical injury benefits provided
under the health benefit plan.
Sec. 5. RULES. The commissioner shall adopt rules as
necessary to administer this article.
SECTION 2. This Act takes effect September 1, 2003, and
applies only to a health benefit plan that is delivered, issued for
delivery, or renewed on or after January 1, 2004. A health benefit
plan that is delivered, issued for delivery, or renewed before
January 1, 2004, is governed by the law as it existed immediately
before the effective date of this Act, and that law is continued in
effect for that purpose.