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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for autism spectrum |
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disorder. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1355.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1355.002. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a group health benefit plan that |
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provides benefits for medical or surgical expenses incurred as a |
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result of a health condition, accident, or sickness, including: |
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(1) a group insurance policy, group insurance |
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agreement, group hospital service contract, or group evidence of |
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coverage that is offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; or |
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(E) a health maintenance organization operating |
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under Chapter 843; and |
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(2) to the extent permitted by the Employee Retirement |
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Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a plan |
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offered under: |
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(A) a multiple employer welfare arrangement as |
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defined by Section 3 of that Act; or |
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(B) another analogous benefit arrangement. |
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(b) Notwithstanding any provision in Chapter 1575 or 1579 or |
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any other law, Section 1355.015 applies to: |
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(1) a basic plan under Chapter 1575; and |
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(2) a primary care coverage plan under Chapter 1579. |
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SECTION 2. Section 1355.015(a), Insurance Code, is amended |
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to read as follows: |
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(a) At a minimum, a health benefit plan must provide |
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coverage as provided by this section to an enrollee [older than two
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years of age and younger than six years of age] who is diagnosed |
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with autism spectrum disorder from the date of diagnosis until the |
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enrollee completes nine years of age. If an enrollee who is being |
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treated for autism spectrum disorder becomes 10 [six] years of age |
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or older and continues to need treatment, this subsection does not |
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preclude coverage of treatment and services described by Subsection |
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(b). |
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SECTION 3. This Act applies only to a health benefit plan |
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delivered, issued for delivery, or renewed on or after January 1, |
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2010. A health benefit plan delivered, issued for delivery, or |
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renewed before January 1, 2010, is governed by the law as it existed |
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immediately before the effective date of this Act, and that law is |
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continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2009. |