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A BILL TO BE ENTITLED
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AN ACT
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relating to certain limitations in health benefit plans and health |
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insurance policies. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1201.227, Insurance Code, is amended to |
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read as follows: |
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Sec. 1201.227. POLICY PROVISION: INTOXICANTS AND |
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NARCOTICS. (a) Except as provided by Subsection (b), an [An] |
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individual accident and health insurance policy must contain the |
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following provision if the policy addresses the subject matter of |
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the provision: |
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"Intoxicants and Narcotics: The insurer is not liable |
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for any loss sustained or contracted in consequence of the |
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insured's being intoxicated or under the influence of any narcotic |
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unless the narcotic is administered on the advice of a physician." |
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(b) An individual accident and health insurance policy may |
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not contain the provision described by Subsection (a) if the policy |
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provides coverage for emergency or other medical, hospital, or |
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surgical expenses incurred by an insured. |
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SECTION 2. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1374 to read as follows: |
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CHAPTER 1374. BENEFITS RELATING TO INJURIES RELATED TO |
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INTOXICATION OR USE OF NARCOTICS |
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Sec. 1374.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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emergency or other medical, hospital, or surgical expenses incurred |
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as a result of a health condition, accident, or sickness, including |
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an individual, group, blanket, or franchise insurance policy or |
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insurance agreement, a group hospital service contract, or an |
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individual or group evidence of coverage or similar coverage |
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document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842 of this code; |
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(3) a health maintenance organization operating under |
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Chapter 843 of this code; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844 of this code; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846 of this code; |
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(6) a stipulated premium insurance company operating |
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under Chapter 884 of this code; |
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(7) a fraternal benefit society operating under |
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Chapter 885 of this code; |
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(8) a Lloyd's plan operating under Chapter 941 of this |
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code; or |
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(9) an exchange operating under Chapter 942 of this |
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code. |
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(b) This chapter applies to: |
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(1) a small employer health benefit plan written under |
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Subchapter B, Chapter 1273, or Chapter 1501; |
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(2) a standard health benefit plan offered under |
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Chapter 1507; |
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(3) basic coverage provided under Chapter 1551, a |
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basic plan provided under Chapter 1575, a primary care coverage |
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plan provided under Chapter 1579, and basic coverage provided under |
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Chapter 1601; and |
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(4) notwithstanding Section 172.014, Local Government |
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Code, or any other law, health and accident coverage provided by a |
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risk pool created under Chapter 172, Local Government Code. |
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(c) This chapter does not apply to: |
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(1) a health benefit plan that provides coverage: |
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(A) only for benefits for a specified disease or |
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for another limited benefit other than an accident policy; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; |
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(E) for credit insurance; or |
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(F) only for dental or vision care; |
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(2) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), |
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as amended; |
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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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an automobile insurance policy; or |
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(5) a long-term care insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefit coverage so |
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comprehensive that the policy is a health benefit plan as described |
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by Subsection (a) of this section. |
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Sec. 1374.002. EXCLUSION OF COVERAGE PROHIBITED. (a) A |
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health benefit plan may not exclude coverage for any emergency or |
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other medical, hospital, or surgical expenses incurred by an |
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insured as a result of and related to an injury acquired while the |
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insured is intoxicated or under the influence of any narcotic, |
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regardless of whether the intoxicant or narcotic is administered on |
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the advice of a health care practitioner. |
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(b) Coverage required under this chapter may be subject to |
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deductibles, copayments, coinsurance, or annual or maximum payment |
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limits that are consistent with deductibles, copayments, |
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coinsurance, or annual or maximum payment limits applicable to |
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other similar coverage under the health benefit plan. |
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Sec. 1374.003. RULES. The commissioner shall adopt rules |
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necessary to implement this chapter. |
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SECTION 3. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2008. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2008, |
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is governed by the law in effect immediately before the effective |
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date of this Act, and that law is continued in effect for that |
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purpose. |
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SECTION 4. This Act takes effect September 1, 2007. |