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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 of hearing aids for |
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certain individuals. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1367, Insurance Code, is amended by |
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adding Subchapter F to read as follows: |
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SUBCHAPTER F. HEARING AIDS |
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Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan, including a small |
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employer health benefit plan written under Chapter 1501 or coverage |
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provided by a health group cooperative under Subchapter B of that |
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chapter, that provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage or similar coverage |
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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 Lloyd's plan operating under Chapter 941; |
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(5) a stipulated premium insurance company operating |
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under Chapter 884; |
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(6) a reciprocal exchange operating under Chapter 942; |
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(7) a health maintenance organization operating under |
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Chapter 843; |
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(8) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(9) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) This subchapter applies to coverage under a group health |
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benefit plan described by Subsection (a) provided to a resident of |
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this state, regardless of whether the group policy or contract is |
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delivered, issued for delivery, or renewed within or outside this |
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state. |
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(c) This subchapter 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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(d) This subchapter applies to a self-funded health benefit |
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plan sponsored by a professional employer organization under |
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Chapter 91, Labor Code. |
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(e) Notwithstanding Section 22.409, Business Organizations |
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Code, or any other law, this subchapter applies to a church benefits |
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board established under Chapter 22, Business Organizations Code. |
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(f) Notwithstanding Section 157.008, Local Government Code, |
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or any other law, this subchapter applies to a county employee |
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health benefit plan established under Chapter 157, Local Government |
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Code. |
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(g) Notwithstanding Section 75.104, Health and Safety Code, |
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or any other law, this subchapter applies to a regional or local |
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health care program established under Chapter 75, Health and Safety |
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Code. |
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(h) Notwithstanding Section 172.014, Local Government Code, |
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or any other law, this subchapter 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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(i) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this subchapter 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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(j) 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 subchapter. |
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Sec. 1367.252. EXCEPTION. This subchapter does not apply |
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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; |
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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 1367.251; |
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(6) a Medicaid managed care program operated under |
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Chapter 533, Government Code; or |
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(7) a Medicaid program operated under Chapter 32, |
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Human Resources Code. |
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Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit |
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plan must provide coverage for the cost of a medically necessary |
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hearing aid and related services and supplies for a covered |
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individual who is 18 years of age or younger. |
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(b) Coverage required under this section is limited to one |
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hearing aid in each ear every three years. |
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(c) Except as provided by Subsection (b), coverage required |
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under this section: |
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(1) may not be less favorable than coverage for |
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physical illness generally under the plan; |
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(2) must be subject to durational limits and |
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coinsurance factors no less favorable than coverage provided for |
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physical illness generally under the plan; and |
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(3) may not be subject to a deductible requirement or |
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dollar limit. |
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(d) This section does not apply to a qualified health plan |
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defined by 45 C.F.R. Section 155.20 if a determination is made under |
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45 C.F.R. Section 155.170 that: |
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(1) this subchapter requires the qualified health plan |
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to offer benefits in addition to the essential health benefits |
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required under 42 U.S.C. Section 18022(b); and |
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(2) this state must make payments to defray the cost of |
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the additional benefits mandated by this subchapter. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2016. A health benefit plan delivered, issued |
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for delivery, or renewed before January 1, 2016, is governed by the |
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law in effect immediately before the effective date of this Act, and |
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that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2015. |