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78R7460 DLF-D

By:  Keffer of Dallas                                             H.B. No. 3107



A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for acute or chronic 
medical conditions.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is 
amended by adding Article 21.53J to read as follows:
	Art. 21.53J.  MAXIMUM LIFETIME BENEFITS FOR ACUTE OR CHRONIC 
MEDICAL CONDITIONS
	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 Lloyd's plan operating under Chapter 941 of this 
code;        
		(6)  an exchange operating under Chapter 942 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 a specified disease or other 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)  only for dental or vision care;                                  
			(F)  only for hospital expenses; or                                   
			(G)  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;
		(5)  a credit 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).
	Sec. 2.  MAXIMUM LIFETIME BENEFIT.  A health benefit plan 
that limits the maximum lifetime benefit applicable to an acute or 
chronic medical condition of an individual covered under the plan 
to a specified dollar amount may not limit the benefit to an amount 
less than $5 million.
	Sec. 3.  RULES.  The commissioner may adopt rules as 
necessary to implement this article. The rules may specify the 
types of acute or chronic medical conditions to which the 
restriction of Section 2 of this article applies.
	SECTION 2.  Section 11, Article 3.77, Insurance Code, is 
amended by adding Subsection (f) to read as follows:
	(f)  Coverage provided by the pool is subject to Article 
21.53J of this code.
	SECTION 3.  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 as it existed immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.