78R1421 DLF-D

By:  Capelo                                                       H.B. No. 1923



A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for immunizations.                   
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.   Subchapter E, Chapter 21, Insurance Code, is 
amended by adding Article 21.52I to read as follows:
	Art. 21.52I.  HEALTH BENEFIT PLAN COVERAGE FOR IMMUNIZATIONS            
	Sec. 1.  APPLICABILITY OF ARTICLE.  (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)  a reciprocal 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; or
		(8)  an approved nonprofit health corporation that 
holds a certificate of authority under Chapter 844 of this code.
	(b)  This article applies to a small employer health benefit 
plan written under Chapter 26 of this code.
	(c)  This article does not apply to:                                    
		(1)  a plan that provides coverage:                                    
			(A)  only for benefits for a specified disease or 
for another limited benefit;
			(B)  only for accidental death or dismemberment;                      
			(C)  for wages or payments in lieu of wages for a 
period during which an employee is absent from work because of 
sickness or injury;
			(D)  as a supplement to a liability insurance 
policy;               
			(E)  for credit insurance;                                            
			(F)  only for dental or vision care;                                  
			(G)  only for hospital expenses; or                                   
			(H)  only for indemnity for hospital confinement;                     
		(2)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 
as amended;
		(3)  a workers' compensation insurance policy;                         
		(4)  medical payment insurance coverage provided under 
a motor vehicle insurance policy; or
		(5)  a long-term care insurance 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. 2.  REQUIRED COVERAGE FOR IMMUNIZATIONS.  (a)  A health 
benefit plan must provide coverage for immunizations as recommended 
by the Advisory Committee on Immunization Practices of the Centers 
for Disease Control and Prevention.
	(b)  The coverage required by this section may be subject to 
annual deductibles, copayments, and coinsurance consistent with 
annual deductibles, copayment, and coinsurance required for other 
benefits under the health benefit plan.
	Sec. 3.  COVERAGE FOR CERTAIN CHILDHOOD 
IMMUNIZATIONS.  This article does not apply to an immunization for 
which coverage is required under:
		(1)  Section 3, Article 21.53F, Insurance Code, as 
added by Chapter 683, Acts of the 75th Legislature, Regular 
Session, 1997; or
		(2)  Section 9F, Texas Health Maintenance Organization 
Act (Article 20A.09F, Vernon's Texas Insurance Code).
	Sec. 4.  RULES.  The commissioner may adopt rules as 
necessary to implement this article.
	SECTION 2.   This Act takes effect September 1, 2003, and 
applies only to a health benefit plan delivered, issued for 
delivery, or renewed on or after January 1, 2004. A health benefit 
plan delivered, issued for delivery, or renewed before January 1, 
2004, is governed by the law in effect immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.