78R5799 KCR-D

By:  Eiland                                                       H.B. No. 2782



A BILL TO BE ENTITLED

AN ACT

relating to certain limitations in health benefit plan coverage 
policies.   
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 3(C), Chapter 397, Acts of the 54th 
Legislature, Regular Session, 1955 (Article 3.70-3, Vernon's Texas 
Insurance Code), is amended to read as follows:
	(C)  INAPPLICABLE OR INCONSISTENT PROVISIONS.  (a) If any 
provision of this section is in whole or in part inapplicable to or 
inconsistent with the coverage provided by a particular form of 
policy the insurer, with the approval of the commissioner [Board], 
shall omit from such policy any inapplicable provision or part of a 
provision, and shall modify any inconsistent provision or part of 
the provision in such manner as to make the provision as contained 
in the policy consistent with the coverage provided by the policy.
	(b)  The provision described by Paragraph (B)(9) of this 
section may not be included in any accident or sickness insurance 
policy that provides coverage for emergency or other medical, 
hospital, or surgical expenses incurred by an insured.
	SECTION 2.  Subchapter E, Chapter 21, Insurance Code, is 
amended by adding Article 21.53X to read as follows:
	Art. 21.53X.  REQUIRED HEALTH BENEFIT COVERAGE FOR INJURIES 
RELATED TO INTOXICATION OR USE OF NARCOTICS
	Sec. 1.  APPLICABILITY OF ARTICLE.  (a)  This article applies 
only to a health benefit plan that provides benefits for emergency 
or other medical, hospital, 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 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)  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; or                                         
			(F)  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)  A health 
benefit plan may not exclude coverage for any emergency or other 
medical, hospital, or surgical expenses incurred by an insured as a 
result of and related to an injury acquired while the insured is 
intoxicated or under the influence of any narcotic, regardless of 
whether the intoxicant or narcotic is administered on the advice of 
a health care practitioner.
	(b)  Coverage required under this article may be subject to 
deductibles, copayments, coinsurance, or annual or maximum payment 
limits that are consistent with deductibles, copayments, 
coinsurance, or annual or maximum payment limits applicable to 
other similar coverage under the plan.
	(c)  The commissioner shall adopt rules as necessary to 
implement this chapter.
	SECTION 3.  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 the former law is 
continued in effect for that purpose.