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