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2003S0314-1 02/18/03


By:  Lucio                                                        S.B. No. 563


A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for an enrollee with 
autism and pervasive developmental disorders.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.   Subchapter E, Chapter 21, Insurance Code, is 
amended by adding Article 21.53X to read as follows:
	Art. 21.53X.  INDIVIDUAL OR GROUP HEALTH BENEFIT PLAN 
COVERAGE FOR ENROLLEE WITH AUTISM OR PERVASIVE DEVELOPMENTAL 
DISORDER
	Sec. 1.  DEFINITION.  In this article, "enrollee" means a 
person entitled to coverage under a health benefit plan.
	Sec. 2.  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 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)  Notwithstanding Section 172.014, Local Government Code, 
or any other law, this article applies to health and accident 
coverage provided by a risk pool created under Chapter 172, Local 
Government 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 a plan that provides 
benefits for mental health or similar services;
			(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; or                               
			(F)  only for indemnity for hospital confinement;                     
		(2)  a small employer health benefit plan written under 
Chapter 26 of this code;
		(3)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 
as amended;
		(4)  a workers' compensation insurance policy;                         
		(5)  medical payment insurance coverage provided under 
a motor vehicle insurance policy; or
		(6)  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. 3.  EXCLUSION OF COVERAGE AND DENIAL OF BENEFITS 
PROHIBITED.  A health benefit plan may not exclude coverage or deny 
benefits otherwise available to an enrollee for treatment, 
equipment, or therapy based on the enrollee's having autism or a 
pervasive developmental disorder.
	Sec. 4.  RULES.  The commissioner shall adopt rules as 
necessary to administer 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 as it existed immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.