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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 acute or chronic |
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medical conditions. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1377 to read as follows: |
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CHAPTER 1377. MAXIMUM LIFETIME BENEFITS FOR ACUTE OR CHRONIC |
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MEDICAL CONDITIONS |
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Sec. 1377.001. 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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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage 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; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) an exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) This chapter 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 chapter 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 chapter 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 chapter. |
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(f) Notwithstanding Section 1501.251 or any other law, this |
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chapter applies to coverage under a small employer health benefit |
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plan subject to Chapter 1501. |
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Sec. 1377.002. EXCEPTION. This chapter does not apply to: |
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(1) a plan that provides coverage: |
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(A) 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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(B) as a supplement to a liability insurance |
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policy; |
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(C) for credit insurance; |
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(D) only for dental or vision care; |
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(E) only for hospital expenses; or |
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(F) only for indemnity for hospital confinement; |
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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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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; or |
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(5) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides benefit coverage so comprehensive that the policy |
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is a health benefit plan as described by Section 1377.001. |
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Sec. 1377.003. MAXIMUM LIFETIME BENEFIT. A health benefit |
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plan that limits the maximum lifetime benefit applicable to an |
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acute or chronic medical condition of an individual covered under |
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the plan to a specified dollar amount may not limit the benefit to |
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an amount less than $5 million. |
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Sec. 1377.004. RULES. The commissioner may adopt rules in |
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accordance with Subchapter A, Chapter 36, as necessary to implement |
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this article. The rules may specify the types of acute or chronic |
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medical conditions to which the restriction of Section 1377.003 |
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applies. |
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SECTION 2. Section 1506.151, Insurance Code, is amended by |
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adding Subsection (d) to read as follows: |
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(d) Coverage provided by the pool is subject to Chapter |
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1377. |
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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. |