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.