| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to benefits under certain health benefit plans for |
|
|
prenatal care, birth of a child, and postdelivery care. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. The heading of Subchapter B, Chapter 1366, |
|
|
Insurance Code, is amended to read as follows: |
|
|
SUBCHAPTER B. BENEFITS FOR PRENATAL CARE, [MINIMUM INPATIENT STAY
|
|
|
FOLLOWING] BIRTH OF CHILD, AND POSTDELIVERY CARE |
|
|
SECTION 2. Section 1366.053, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1366.053. APPLICABILITY OF SUBCHAPTER. (a) This |
|
|
subchapter applies only to a health benefit plan that: |
|
|
(1) provides benefits for medical or surgical expenses |
|
|
incurred as a result of a health condition, accident, or sickness, |
|
|
including: |
|
|
(A) an individual, group, blanket, or franchise |
|
|
insurance policy or insurance agreement, a group hospital service |
|
|
contract, or an individual or group evidence of coverage that is |
|
|
offered by: |
|
|
(i) an insurance company; |
|
|
(ii) a group hospital service corporation |
|
|
operating under Chapter 842; |
|
|
(iii) a fraternal benefit society operating |
|
|
under Chapter 885; |
|
|
(iv) a stipulated premium company operating |
|
|
under Chapter 884; or |
|
|
(v) a health maintenance organization |
|
|
operating under Chapter 843; and |
|
|
(B) to the extent permitted by the Employee |
|
|
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
|
|
seq.), a health benefit plan that is offered by: |
|
|
(i) a multiple employer welfare arrangement |
|
|
as defined by Section 3 of that Act; |
|
|
(ii) an entity not authorized under this |
|
|
code or another insurance law of this state that contracts directly |
|
|
for health care services on a risk-sharing basis, including a |
|
|
capitation basis; or |
|
|
(iii) another analogous benefit |
|
|
arrangement; or |
|
|
(2) is offered by an approved nonprofit health |
|
|
corporation that holds a certificate of authority under Chapter |
|
|
844. |
|
|
(b) This subchapter applies to group health coverage made |
|
|
available by a school district in accordance with Section 22.004, |
|
|
Education Code. |
|
|
(c) Notwithstanding Section 172.014, Local Government Code, |
|
|
or any other law, this subchapter applies to health and accident |
|
|
coverage provided by a risk pool created under Chapter 172, Local |
|
|
Government Code. |
|
|
(d) Notwithstanding any provision in Chapter 1551, 1575, |
|
|
1579, or 1601 or any other law, this subchapter applies to: |
|
|
(1) a basic coverage plan under Chapter 1551; |
|
|
(2) a basic plan under Chapter 1575; |
|
|
(3) a primary care coverage plan under Chapter 1579; |
|
|
and |
|
|
(4) basic coverage under Chapter 1601. |
|
|
(e) Notwithstanding any other law, a standard health |
|
|
benefit plan provided under Chapter 1507 must provide the coverage |
|
|
required by this subchapter. |
|
|
(f) Notwithstanding Section 1451.253, Section 1501.251, or |
|
|
any other law, this subchapter applies to coverage under a small |
|
|
employer health benefit plan subject to Chapter 1501. |
|
|
SECTION 3. Subchapter B, Chapter 1366, Insurance Code, is |
|
|
amended by adding Sections 1366.0545, 1366.0546, and 1366.0547 to |
|
|
read as follows: |
|
|
Sec. 1366.0545. COVERAGE FOR PRENATAL CARE REQUIRED. A |
|
|
health benefit plan must provide to a pregnant enrollee benefits |
|
|
for prenatal care recommended under generally accepted standards of |
|
|
medical practice or that is medically necessary for the enrollee. |
|
|
Sec. 1366.0546. COVERAGE FOR BIRTH OF CHILD REQUIRED. A |
|
|
health benefit plan must provide coverage to an enrollee who is a |
|
|
woman for medical and other health care services provided to the |
|
|
enrollee and the enrollee's child in connection with the birth of |
|
|
the child. |
|
|
Sec. 1366.0547. ACCESS TO OBSTETRICAL OR GYNECOLOGICAL |
|
|
CARE. Except as otherwise provided by this subchapter, coverage |
|
|
under Sections 1366.0545 and 1366.0546 is subject to Subchapter F, |
|
|
Chapter 1451. |
|
|
SECTION 4. Section 1366.055(a), Insurance Code, is amended |
|
|
to read as follows: |
|
|
(a) Except as provided by Subsection (b), a health benefit |
|
|
plan [that provides maternity benefits, including benefits for
|
|
|
childbirth,] must provide to a woman who has given birth to a child |
|
|
and the newborn child coverage for inpatient care in a health care |
|
|
facility for not less than: |
|
|
(1) 48 hours after an uncomplicated vaginal delivery; |
|
|
and |
|
|
(2) 96 hours after an uncomplicated delivery by |
|
|
cesarean section. |
|
|
SECTION 5. Section 1366.059, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1366.059. RULES. The commissioner, in accordance |
|
|
with Subchapter A, Chapter 36, shall adopt rules necessary to |
|
|
administer this subchapter. The rules may coordinate benefits |
|
|
required under this subchapter with analogous benefits required |
|
|
under federal law. |
|
|
SECTION 6. This Act applies only to a health benefit plan |
|
|
that is delivered, issued for delivery, or renewed on or after |
|
|
January 1, 2008. A health benefit plan that is delivered, issued for |
|
|
delivery, or renewed before January 1, 2008, is governed by the law |
|
|
as it existed immediately before the effective date of this Act, and |
|
|
that law is continued in effect for this purpose. |
|
|
SECTION 7. This Act takes effect September 1, 2007. |