80R8574 DLF-F

By: Averitt S.B. No. 1681

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for children and grandchildren.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 846.260, Insurance Code, is amended to read as follows:

Sec. 846.260. LIMITING AGE APPLICABLE TO [UNMARRIED] CHILD. Children [If children] are eligible for coverage under the terms of a multiple employer welfare arrangement's plan document, and there is no [any] limiting age applicable to a [an unmarried] child of an enrollee [is 25 years of age].

SECTION 2. Section 1201.062(a), Insurance Code, is amended to read as follows:

(a) An individual or group accident and health insurance policy that is delivered, issued for delivery, or renewed in this state, including a policy issued by a corporation operating under Chapter 842, or a self-funded or self-insured welfare or benefit plan or program, to the extent that regulation of the plan or program is not preempted by federal law, must provide [that provides] coverage for a child of an insured or group member, on payment of a premium, and must provide coverage for:

(1) each grandchild of the insured or group member [if the grandchild is:

[(A)unmarried;

[(B)younger than 25 years of age; and

[(C) a dependent of the insured or group member for federal income tax purposes at the time application for coverage of the grandchild is made]; and

(2) each child for whom the insured or group member must provide medical support under an order issued under Chapter 154, Family Code, or enforceable by a court in this state.

SECTION 3. Section 1251.151(a), Insurance Code, is amended to read as follows:

(a) A group policy or contract of insurance for hospital, surgical, or medical expenses incurred as a result of accident or sickness, including a group contract issued by a group hospital service corporation, that provides coverage under the policy or contract for a child of an insured must, on payment of a premium, provide coverage for any grandchild of the insured [if the grandchild is:

[(1)unmarried;

[(2)younger than 25 years of age; and

[(3) a dependent of the insured for federal income tax purposes at the time the application for coverage of the grandchild is made].

SECTION 4. Section 1251.152, Insurance Code, is amended to read as follows:

Sec. 1251.152. OPTIONAL COVERAGE FOR SPOUSES AND DEPENDENTS. (a) For purposes of this section, "dependent" includes:

(1) a child of an employee or member [who is:

[(A)unmarried; and

[(B)younger than 25 years of age]; and

(2) a grandchild of an employee or member [who is:

[(A)unmarried;

[(B)younger than 25 years of age; and

[(C) a dependent of the insured for federal income tax purposes at the time the application for coverage of the grandchild is made].

(b) A group accident and health insurance policy must [may] provide coverage for the spouse or a dependent of an employee or member.

SECTION 5. Section 1271.006, Insurance Code, is amended to read as follows:

Sec. 1271.006. BENEFITS TO DEPENDENT CHILD AND GRANDCHILD. Children [(a) If children] are eligible for coverage under the terms of an evidence of coverage, and there is no [any] limiting age applicable to a [an unmarried] child of an enrollee, including a [an unmarried] grandchild of an enrollee[, is 25 years of age. The limiting age applicable to a child must be stated in the evidence of coverage.

[(b) A health maintenance organization may provide benefits under a health care plan to an enrollee's dependent grandchild who is living with and in the household of the enrollee].

SECTION 6. Section 1501.002(2), Insurance Code, is amended to read as follows:

(2) "Dependent" means:

(A) a spouse;

(B) a child [younger than 25 years of age], including a newborn child;

(C) [a child of any age who is:

[(i)medically certified as disabled; and

[(ii)dependent on the parent;

[(D)] an individual who must be covered under:

(i) Section 1251.154; or

(ii) Section 1201.062; and

(D) [(E)] any other child eligible under an employer's health benefit plan, including a child described by Section 1503.003.

SECTION 7. Section 1501.609, Insurance Code, is amended to read as follows:

Sec. 1501.609. COVERAGE FOR [UNMARRIED] CHILDREN. Children [(a) This section applies only if children] are eligible for coverage under a large employer health benefit plan.

[(b) Any limiting age applicable under a large employer health benefit plan to an unmarried child of an enrollee is 25 years of age.]

SECTION 8. Section 1575.003(1), Insurance Code, is amended to read as follows:

(1) "Dependent" means:

(A) the spouse of a retiree; or

(B) a [an unmarried] child of a retiree or deceased active member [if the child is younger than 25 years of age], including:

(i) an adopted child;

(ii) a foster child, stepchild, or other child who is in a regular parent-child relationship; or

(iii) a recognized natural child[;

[(C) a retiree's recognized natural child, adopted child, foster child, stepchild, or other child who is in a regular parent-child relationship and who lives with or has his or her care provided by the retiree or surviving spouse on a regular basis regardless of the child's age, if the child is mentally retarded or physically incapacitated to an extent that the child is dependent on the retiree or surviving spouse for care or support, as determined by the trustee; or

[(D) a deceased active member's recognized natural child, adopted child, foster child, stepchild, or other child who is in a regular parent-child relationship, without regard to the age of the child, if, while the active member was alive, the child:

[(i) lived with or had the child's care provided by the active member on a regular basis; and

[(ii) was mentally retarded or physically incapacitated to an extent that the child was dependent on the active member or surviving spouse for care or support, as determined by the trustee].

SECTION 9. Section 1601.004(a), Insurance Code, is amended to read as follows:

(a) In this chapter, "dependent," with respect to an individual eligible to participate in the uniform program under Section 1601.101 or 1601.102, means the individual's:

(1) spouse; and

(2) [unmarried] child [younger than 25 years of age; and

[(3) child of any age who lives with or has the child's care provided by the individual on a regular basis if the child is mentally retarded or physically incapacitated to the extent that the child is dependent on the individual for care or support, as determined by the system].

SECTION 10. Section 1201.065 and Chapter 1503, Insurance Code, are repealed.

SECTION 11. The changes in law made by this Act apply only to a health benefit plan, the contract, policy, or evidence of coverage for which is delivered, issued for delivery, or renewed on or after the effective date of this Act. A health benefit plan, the contract, policy, or evidence of coverage for which is delivered, issued for delivery, or renewed before the effective date of this Act, is covered by the law in effect at the time the contract, policy, or evidence of coverage is delivered, issued for delivery, or renewed, and that law is continued in effect for that purpose.

SECTION 12. This Act takes effect September 1, 2007.