83R5976 KKR-D
 
  By: Coleman H.B. No. 3226
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit plan coverage for certain physical
  injuries that are self-inflicted by a minor.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle E, Title 8, Insurance Code, is amended
  by adding Chapter 1373 to read as follows:
  CHAPTER 1373. COVERAGE FOR CERTAIN SELF-INFLICTED
  PHYSICAL INJURIES BY MINORS
         Sec. 1373.001.  DEFINITIONS.  In this chapter:
               (1)  "Enrollee" means an individual entitled to
  coverage under a health benefit plan.
               (2)  "Serious mental illness" has the meaning assigned
  by Section 1355.001 and also includes a diagnosable behavioral or
  emotional disorder or a neuropsychiatric condition:
                     (A)  that results in a serious disability
  requiring sustained treatment interventions;
                     (B)  that is of sufficient duration to meet
  diagnostic criteria specified in the American Psychiatric
  Association's Diagnostic and Statistical Manual of Mental
  Disorders designated DSM-IV-TR, or in a subsequent edition of that
  manual that the commissioner adopts to take the place of that
  edition or any subsequent edition for the purposes of this
  subdivision; and
                     (C)  with respect to which the affected person
  exhibits impairment in thought, perception, affect, or behavior
  that substantially interferes with or limits the person's role or
  functioning in the person's community, school, family, or peer
  group.
         Sec. 1373.002.  APPLICABILITY OF CHAPTER. (a) This chapter
  applies only to a health benefit plan that provides benefits for
  medical 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;
               (3)  a fraternal benefit society operating under
  Chapter 885;
               (4)  a stipulated premium insurance company operating
  under Chapter 884;
               (5)  a reciprocal exchange operating under Chapter 942;
               (6)  a health maintenance organization operating under
  Chapter 843;
               (7)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846; or
               (8)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844.
         (b)  This chapter applies to group health coverage made
  available by a school district in accordance with Section 22.004,
  Education Code.
         (c)  Notwithstanding Section 172.014, Local Government Code,
  or any other law, this chapter applies to health and accident
  coverage provided by a risk pool created under Chapter 172, Local
  Government Code.
         (d)  Notwithstanding any provision in Chapter 1551, 1575,
  1579, or 1601 or any other law, this chapter applies to:
               (1)  a basic coverage plan under Chapter 1551;
               (2)  a basic plan under Chapter 1575;
               (3)  a primary care coverage plan under Chapter 1579;
  and
               (4)  basic coverage under Chapter 1601.
         (e)  Notwithstanding any other law, a standard health
  benefit plan provided under Chapter 1507 must provide the coverage
  required by this chapter.
         Sec. 1373.003.  EXCEPTION.  This chapter does not apply to:
               (1)  a plan that provides coverage:
                     (A)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (B)  as a supplement to a liability insurance
  policy;
                     (C)  for credit insurance;
                     (D)  only for dental or vision care;
                     (E)  only for hospital expenses; or
                     (F)  only for indemnity for hospital confinement;
               (2)  a small employer health benefit plan written under
  Chapter 1501, except when an independent school district elects to
  participate in a small employer market in accordance with Section
  1501.009;
               (3)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
               (4)  a workers' compensation insurance policy;
               (5)  medical payment insurance coverage provided under
  a motor vehicle insurance policy; or
               (6)  a long-term care 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 Section 1373.002.
         Sec. 1373.004.  COVERAGE REQUIRED. Regardless of whether a
  health benefit plan provides mental health coverage, a health
  benefit plan must provide coverage for an enrollee, from birth
  through the date the enrollee is 18 years of age, for a physical
  injury to the enrollee that is self-inflicted:
               (1)  in an attempt to commit suicide, regardless of:
                     (A)  the state of mental health of the enrollee;
  or
                     (B)  whether the injury results in the death of
  the enrollee; or
               (2)  by an enrollee with a serious mental illness.
         Sec. 1373.005.  DEDUCTIBLE, COINSURANCE, AND COPAYMENT
  REQUIREMENTS. The benefits required under this chapter may not be
  made subject to a deductible, coinsurance, or copayment requirement
  that exceeds the deductible, coinsurance, or copayment
  requirements applicable to other physical injury benefits provided
  under the health benefit plan.
         Sec. 1373.006.  RULES.  The commissioner shall adopt rules
  as necessary to administer this chapter.
         SECTION 2.  This Act applies only to a health benefit plan
  that is delivered, issued for delivery, or renewed on or after
  January 1, 2014.  A health benefit plan that is delivered, issued
  for delivery, or renewed before January 1, 2014, is governed by the
  law as it existed immediately before the effective date of this Act,
  and that law is continued in effect for that purpose.
         SECTION 3.  This Act takes effect September 1, 2013.