79R1458 KCR-F


By:  Eiland                                                       H.B. No. 949



A BILL TO BE ENTITLED

AN ACT

relating to certain limitations in health benefit plans and health 
insurance policies.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Section 1201.227, Insurance Code, as effective 
April 1, 2005, is amended to read as follows:
	Sec. 1201.227.  POLICY PROVISION:  INTOXICANTS AND 
NARCOTICS.  (a)  Except as provided by Subsection (b), an [An] 
individual accident and health insurance policy must contain the 
following provision if the policy addresses the subject matter of 
the provision:
		"Intoxicants and Narcotics:  The insurer is not liable 
for any loss sustained or contracted in consequence of the 
insured's being intoxicated or under the influence of any narcotic 
unless the narcotic is administered on the advice of a physician."
	(b)  An individual accident and health insurance policy may 
not contain the provision described by Subsection (a) if the policy 
provides coverage for emergency or other medical, hospital, or 
surgical expenses incurred by an insured.
	SECTION 2.  Subtitle E, Title 8, Insurance Code, as 
effective April 1, 2005, is amended by adding Chapter 1370 to read 
as follows:
	CHAPTER 1370.  BENEFITS RELATING TO INJURIES RELATED TO 
INTOXICATION OR USE OF NARCOTICS
	Sec. 1370.001.  APPLICABILITY OF CHAPTER.  (a)  This chapter 
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 health maintenance organization operating under 
Chapter 843 of this code;
		(4)  an approved nonprofit health corporation that 
holds a certificate of authority under Chapter 844 of this code;
		(5)  a multiple employer welfare arrangement that holds 
a certificate of authority under Chapter 846 of this code;
		(6)  a stipulated premium insurance company operating 
under Chapter 884 of this code;
		(7)  a fraternal benefit society operating under 
Chapter 885 of this code;
		(8)  a Lloyd's plan operating under Chapter 941 of this 
code; or     
		(9)  an exchange operating under Chapter 942 of this 
code.           
	(b)  This chapter applies to a small employer health benefit 
plan written under Subchapter B, Chapter 1273, or Chapter 1501.
	(c)  This chapter does not apply to:                                    
		(1)  a health benefit 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 
an automobile 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. 1370.002.  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 chapter 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 health benefit plan.
	Sec. 1370.003.  RULES.  The commissioner shall adopt rules 
necessary to implement this chapter.
	SECTION 3.  The change in law made by this Act applies only 
to a health benefit plan that is delivered, issued for delivery, or 
renewed on or after January 1, 2006.  A health benefit plan that is 
delivered, issued for delivery, or renewed before January 1, 2006, 
is governed by the law in effect immediately before the effective 
date of this Act, and that law is continued in effect for that 
purpose.
	SECTION 4.  This Act takes effect September 1, 2005.