| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to certain limitations in health benefit plans and health |
|
|
insurance policies. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1201.227, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1201.227. POLICY PROVISION: INTOXICANTS AND |
|
|
NARCOTICS. (a) Except as provided by Subsection (b), an [An] |
|
|
individual accident and health insurance policy must contain the |
|
|
following provision if the policy addresses the subject matter of |
|
|
the provision: |
|
|
"Intoxicants and Narcotics: The insurer is not liable for |
|
|
any loss sustained or contracted in consequence of the insured's |
|
|
being intoxicated or under the influence of any narcotic unless the |
|
|
narcotic is administered on the advice of a physician." |
|
|
(b) An individual accident and health insurance policy may |
|
|
not contain the provision described by Subsection (a) if the policy |
|
|
provides coverage for emergency or other medical, hospital, or |
|
|
surgical expenses incurred by an insured. |
|
|
SECTION 2. Subtitle E, Title 8, Insurance Code, is amended |
|
|
by adding Chapter 1374 to read as follows: |
|
|
CHAPTER 1374. BENEFITS RELATING TO INJURIES RELATED TO |
|
|
INTOXICATION OR USE OF NARCOTICS |
|
|
Sec. 1374.001. APPLICABILITY OF CHAPTER. (a) This chapter |
|
|
applies only to a health benefit plan that provides benefits for |
|
|
emergency or other medical, hospital, or surgical expenses incurred |
|
|
as a result of a health condition, accident, or sickness, including |
|
|
an individual, group, blanket, or franchise insurance policy or |
|
|
insurance agreement, a group hospital service contract, or an |
|
|
individual or group evidence of coverage or similar coverage |
|
|
document that is offered by: |
|
|
(1) an insurance company; |
|
|
(2) a group hospital service corporation operating |
|
|
under Chapter 842 of this code; |
|
|
(3) a health maintenance organization operating under |
|
|
Chapter 843 of this code; |
|
|
(4) an approved nonprofit health corporation that |
|
|
holds a certificate of authority under Chapter 844 of this code; |
|
|
(5) a multiple employer welfare arrangement that holds |
|
|
a certificate of authority under Chapter 846 of this code; |
|
|
(6) a stipulated premium insurance company operating |
|
|
under Chapter 884 of this code; |
|
|
(7) a fraternal benefit society operating under |
|
|
Chapter 885 of this code; |
|
|
(8) a Lloyd's plan operating under Chapter 941 of this |
|
|
code; or |
|
|
(9) an exchange operating under Chapter 942 of this |
|
|
code. |
|
|
(b) This chapter applies to: |
|
|
(1) a small employer health benefit plan written under |
|
|
Subchapter B, Chapter 1273, or Chapter 1501; |
|
|
(2) a standard health benefit plan offered under |
|
|
Chapter 1507; |
|
|
(3) basic coverage provided under Chapter 1551, a |
|
|
basic plan provided under Chapter 1575, a primary care coverage |
|
|
plan provided under Chapter 1579, and basic coverage provided under |
|
|
Chapter 1601; and |
|
|
(4) notwithstanding Section 172.014, Local Government |
|
|
Code, or any other law, health and accident coverage provided by a |
|
|
risk pool created under Chapter 172, Local Government Code. |
|
|
(c) This chapter does not apply to: |
|
|
(1) a health benefit plan that provides coverage: |
|
|
(A) only for benefits for a specified disease or |
|
|
for another limited benefit other than an accident policy; |
|
|
(B) only for accidental death or dismemberment; |
|
|
(C) for wages or payments in lieu of wages for a |
|
|
period during which an employee is absent from work because of |
|
|
sickness or injury; |
|
|
(D) as a supplement to a liability insurance |
|
|
policy; |
|
|
(E) for credit insurance; or |
|
|
(F) only for dental or vision care; |
|
|
(2) a Medicare supplemental policy as defined by |
|
|
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), |
|
|
as amended; |
|
|
(3) a workers' compensation insurance policy; |
|
|
(4) medical payment insurance coverage provided under |
|
|
an automobile insurance policy; or |
|
|
(5) a long-term care insurance policy, including a |
|
|
nursing home fixed indemnity policy, unless the commissioner |
|
|
determines that the policy provides benefit coverage so |
|
|
comprehensive that the policy is a health benefit plan as described |
|
|
by Subsection (a) of this section. |
|
|
Sec. 1374.002. EXCLUSION OF COVERAGE PROHIBITED. (a) A |
|
|
health benefit plan may not exclude coverage for any emergency or |
|
|
other medical, hospital, or surgical expenses incurred by an |
|
|
insured as a result of and related to an injury acquired while the |
|
|
insured is intoxicated or under the influence of any narcotic, |
|
|
regardless of whether the intoxicant or narcotic is administered on |
|
|
the advice of a health care practitioner. |
|
|
(b) Coverage required under this chapter may be subject to |
|
|
deductibles, copayments, coinsurance, or annual or maximum payment |
|
|
limits that are consistent with deductibles, copayments, |
|
|
coinsurance, or annual or maximum payment limits applicable to |
|
|
other similar coverage under the health benefit plan. |
|
|
Sec. 1374.003. RULES. The commissioner shall adopt rules |
|
|
necessary to implement this chapter. |
|
|
SECTION 3. The change in law made by this Act applies only |
|
|
to a health benefit plan that is delivered, issued for delivery, or |
|
|
renewed on or after January 1, 2012. A health benefit plan that is |
|
|
delivered, issued for delivery, or renewed before January 1, 2012, |
|
|
is governed by the law in effect immediately before the effective |
|
|
date of this Act, and that law is continued in effect for that |
|
|
purpose. |
|
|
SECTION 4. This Act takes effect September 1, 2011. |