81R10708 AJA-F

By: Averitt S.B. No. 1545

A BILL TO BE ENTITLED

AN ACT

relating to health benefit 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 1201.053(b), Insurance Code, is amended to read as follows:

(b) On the application of an adult member of a family, an individual accident and health insurance policy may, at the time of original issuance or by subsequent amendment, insure two or more eligible members of the adult's family, including:

(1) a spouse;

(2) [, unmarried] children [younger than 25 years of age], including a grandchild of the adult as described by Section 1201.062(a)(1);

(3) [,] a child the adult is required to insure under a medical support order issued under Chapter 154, Family Code, or enforceable by a court in this state;[,] and

(4) any [other] individual dependent on the adult.

SECTION 3. 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 4. 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 5. 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 6. 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 7. 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 8. 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 9. Section 1507.003(b), Insurance Code, is amended to read as follows:

(b) For purposes of this subchapter, "state-mandated health benefits" does not include benefits that are mandated by federal law or standard provisions or rights required under this code or other laws of this state to be provided in an individual, blanket, or group policy for accident and health insurance that are unrelated to a specific health illness, injury, or condition of an insured, including provisions related to:

(1) continuation of coverage under:

(A) Subchapters F and G, Chapter 1251; and

(B) [Section 1201.059; and

[(C)] Subchapter B, Chapter 1253;

(2) termination of coverage under Sections 1202.051 and 1501.108;

(3) preexisting conditions under Subchapter D, Chapter 1201, and Sections 1501.102-1501.105;

(4) coverage of children, including newborn or adopted children, under:

(A) Subchapter D, Chapter 1251;

(B) Sections 1201.053, 1201.061, 1201.063, and 1201.064 [1201.063-1201.065,] and Subchapter A, Chapter 1367;

(C) Chapter 1504;

(D) [Chapter 1503;

[(E)] Section 1501.157;

(E) [(F)] Section 1501.158; and

(F) [(G)] Sections 1501.607-1501.609;

(5) services of practitioners under:

(A) Subchapters A, B, and C, Chapter 1451; or

(B) Section 1301.052;

(6) supplies and services associated with the treatment of diabetes under Subchapter B, Chapter 1358;

(7) coverage for serious mental illness under Subchapter A, Chapter 1355;

(8) coverage for childhood immunizations and hearing screening as required by Subchapters B and C, Chapter 1367, other than Section 1367.053(c) and Chapter 1353;

(9) coverage for reconstructive surgery for certain craniofacial abnormalities of children as required by Subchapter D, Chapter 1367;

(10) coverage for the dietary treatment of phenylketonuria as required by Chapter 1359;

(11) coverage for referral to a non-network physician or provider when medically necessary covered services are not available through network physicians or providers, as required by Section 1271.055; and

(12) coverage for cancer screenings under:

(A) Chapter 1356;

(B) Chapter 1362;

(C) Chapter 1363; and

(D) Chapter 1370.

SECTION 10. Section 1507.053(b), Insurance Code, is amended to read as follows:

(b) For purposes of this subchapter, "state-mandated health benefits" does not include coverage that is mandated by federal law or standard provisions or rights required under this code or other laws of this state to be provided in an evidence of coverage that are unrelated to a specific health illness, injury, or condition of an enrollee, including provisions related to:

(1) continuation of coverage under Subchapter G, Chapter 1251;

(2) termination of coverage under Sections 1202.051 and 1501.108;

(3) preexisting conditions under Subchapter D, Chapter 1201, and Sections 1501.102-1501.105;

(4) coverage of children, including newborn or adopted children, under:

(A) Chapter 1504;

(B) [Chapter 1503;

[(C)] Section 1501.157;

(C) [(D)] Section 1501.158; and

(D) [(E)] Sections 1501.607-1501.609;

(5) services of providers under Section 843.304;

(6) coverage for serious mental health illness under Subchapter A, Chapter 1355; and

(7) coverage for cancer screenings under:

(A) Chapter 1356;

(B) Chapter 1362;

(C) Chapter 1363; and

(D) Chapter 1370.

SECTION 11. Subchapter D, Chapter 1551, Insurance Code, is amended by adding Section 1551.160 to read as follows:

Sec. 1551.160. COVERAGE FOR CERTAIN CHILDREN AND GRANDCHILDREN. (a) Notwithstanding any other provision of this chapter, an employee, annuitant, spouse, or surviving spouse participating in the group benefits program is entitled to obtain health benefit coverage under the program for any child or grandchild of the employee, annuitant, spouse, or surviving spouse without regard to the age of the child.

(b) For a child or grandchild who is covered under this section and who would not otherwise be eligible for coverage under this chapter:

(1) a state contribution is not payable; and

(2) the employee, annuitant, spouse, or surviving spouse must pay, in the manner required by the board of trustees, the total cost, as determined by the board, attributable to the participation of the child or grandchild.

SECTION 12. 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 13. Subchapter D, Chapter 1575, Insurance Code, is amended by adding Section 1575.1575 to read as follows:

Sec. 1575.1575. COVERAGE FOR CERTAIN CHILDREN AND GRANDCHILDREN. (a) Notwithstanding any other provision of this chapter, a retiree, spouse, or surviving spouse participating in the group program is entitled to obtain health coverage plan coverage under the program for any child or grandchild of the retiree, spouse, or surviving spouse without regard to the age of the child.

(b) For a child or grandchild who is covered under this section and who would not otherwise be eligible for coverage under this chapter:

(1) a state contribution is not payable; and

(2) the retiree, spouse, or surviving spouse must pay, in the manner required by the trustee, the total cost, as determined by the trustee, attributable to the participation of the child or grandchild.

SECTION 14. The heading of Subchapter E, Chapter 1579, Insurance Code, is amended to read as follows:

SUBCHAPTER E. PARTICIPATION BY EMPLOYEE OR DEPENDENT

SECTION 15. Subchapter E, Chapter 1579, Insurance Code, is amended by adding Section 1579.206 to read as follows:

Sec. 1579.206. COVERAGE FOR CERTAIN CHILDREN AND GRANDCHILDREN. (a) Notwithstanding any other provision of this chapter, an employee or spouse participating in the program is entitled to obtain health coverage plan coverage under the program for any child or grandchild of the employee or spouse without regard to the age of the child.

(b) For a child or grandchild who is covered under this section and who would not otherwise be eligible for coverage under this chapter:

(1) a state contribution is not payable; and

(2) the employee or spouse must pay, in the manner required by the trustee, the total cost, as determined by the trustee, attributable to the participation of the child or grandchild.

SECTION 16. 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 17. Subchapter C, Chapter 1601, Insurance Code, is amended by adding Section 1601.112 to read as follows:

Sec. 1601.112. COVERAGE FOR CERTAIN CHILDREN AND GRANDCHILDREN. (a) Notwithstanding any other provision of this chapter, an employee, retiree, spouse, or surviving spouse participating in a uniform program is entitled to obtain health benefit coverage under the program for any child or grandchild of the employee, retiree, spouse, or surviving spouse without regard to the age of the child.

(b) For a child or grandchild who is covered under this section and who would not otherwise be eligible for coverage under this chapter:

(1) a state contribution is not payable; and

(2) the employee, retiree, spouse, or surviving spouse must pay, in the manner required by the applicable system, the total cost, as determined by the system, attributable to the participation of the child or grandchild.

SECTION 18. Section 4001.009(a), Insurance Code, is amended to read as follows:

(a) As referenced in Section 4001.003(9), a reference to an agent in the following laws includes a subagent without regard to whether a subagent is specifically mentioned:

(1) Chapters 281, 402, 421-423, 441, 444, 461-463, 523, 541-556, 558, 559, [702,] 703, 705, 821, 823-825, 827, 828, 844, 963, 1108, 1205-1208[1205-1209], 1211-1214, 1352, 1353, 1357, 1358, 1360-1363, 1369, 1453-1455, [1503,] 1550, 1801, 1803, 2151-2154, 2201-2203, 2205-2213, 3501, 3502, 4007, 4102, and 4201-4203;

(2) Chapter 403, excluding Section 403.002;

(3) Subchapter A, Chapter 491;

(4) Subchapter C, Chapter 521;

(5) Subchapter A, Chapter 557;

(6) Subchapter B, Chapter 805;

(7) Subchapters D, E, and F, Chapter 982;

(8) Subchapter D, Chapter 1103;

(9) Subchapters B, C, D, and E, Chapter 1204, excluding Sections 1204.153 and 1204.154;

(10) Subchapter B, Chapter 1366;

(11) Subchapters B, C, and D, Chapter 1367, excluding Section 1367.053(c);

(12) Subchapters A, C, D, E, F, H, and I, Chapter 1451;

(13) Subchapter B, Chapter 1452;

(14) Sections 551.004, 841.303, 982.001, 982.002, 982.004, 982.052, 982.102, 982.103, 982.104, 982.106, 982.107, 982.108, 982.110, 982.111, 982.112, and 1802.001; and

(15) Chapter 107, Occupations Code.

SECTION 19. The following laws are repealed:

(1) Sections 1201.059 and 1201.065, Insurance Code; and

(2) Chapter 1503, Insurance Code.

SECTION 20. 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 21. This Act takes effect September 1, 2009.