78R6729 AKH-D
By: Burnam H.B. No. 2262
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for persons engaged in
dangerous activities.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
amended by adding Article 21.53T to read as follows:
Art. 21.53T. HEALTH BENEFIT PLAN COVERAGE FOR PERSONS
ENGAGED IN DANGEROUS ACTIVITIES
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) an exchange operating under Chapter 942 of this
code;
(6) a Lloyd's plan operating under Chapter 941 of this
code;
(7) a health maintenance organization operating under
Chapter 843 of this code;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846 of this code; or
(9) 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 applies to a plan that provides coverage:
(1) only for accidental death or dismemberment;
(2) only for hospital expenses; or
(3) only for indemnity for hospital confinement.
(d) 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 other than an accident policy;
(B) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(C) as a supplement to a liability insurance
policy;
(D) for credit insurance; or
(E) only for dental or vision care;
(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. EXCLUSION OF COVERAGE PROHIBITED. (a) This article
applies to a person engaged in any lawful activity that could be
considered dangerous.
(b) A health benefit plan may not:
(1) exclude a person engaged in the dangerous activity
from coverage for health benefits under the plan;
(2) consider the activity as a risk factor in
determining the person's premium payable under the plan; or
(3) exclude coverage for health benefits for injuries
sustained as a result of engaging in the activity.
(c) The commissioner shall adopt rules as necessary to
implement this section.
SECTION 2. This Act takes effect September 1, 2003, and
applies only to an insurance policy delivered, issued for delivery,
or renewed on or after January 1, 2004. A policy 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.