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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 preexisting conditions. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle G, Title 8, Insurance Code, is amended |
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by adding Chapter 1509 to read as follows: |
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CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS |
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Sec. 1509.001. DEFINITION. In this chapter, "preexisting |
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condition" means a condition present before the effective date of |
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an individual's coverage under a health benefit plan. |
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Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan, including a small employer |
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health benefit plan written under Chapter 1501 or coverage provided |
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through 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 chapter 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, agreement, or |
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contract is delivered, issued for delivery, or renewed within or |
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outside this state. |
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(c) 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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(d) This chapter 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 chapter applies to health benefits |
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provided by or through a church benefits board under Subchapter I, |
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Chapter 22, Business Organizations Code. |
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(f) Notwithstanding Sections 157.008 and 157.106, Local |
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Government Code, or any other law, this chapter applies to a county |
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employee health benefit plan provided under Chapter 157, Local |
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Government Code. |
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(g) Notwithstanding Section 75.104, Health and Safety Code, |
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or any other law, this chapter applies to a regional or local health |
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care program operated under that section. |
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(h) 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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(i) 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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(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 chapter. |
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(k) To the extent allowed by federal law, the child health |
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plan program operated under Chapter 62, Health and Safety Code, the |
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state Medicaid program, and a managed care organization that |
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contracts with the Health and Human Services Commission to provide |
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health care services to recipients through a managed care plan |
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shall provide the coverage required under this chapter to a |
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recipient. |
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Sec. 1509.003. EXCEPTIONS. (a) This chapter 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 |
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1395ss(g)(1)); |
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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 1509.002. |
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(b) This chapter does not apply to an individual health |
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benefit plan issued on or before March 23, 2010, that has not had |
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any significant changes since that date that reduce benefits or |
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increase costs to the individual. |
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Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS |
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PROHIBITED. Notwithstanding any other law, a health benefit plan |
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issuer may not: |
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(1) deny an individual's application for coverage or |
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refuse to enroll an individual in a group health benefit plan due to |
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a preexisting condition; |
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(2) limit or exclude coverage under the health benefit |
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plan for the treatment of a preexisting condition otherwise covered |
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under the plan; or |
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(3) charge the individual more for coverage than the |
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health benefit plan issuer charges an individual who does not have a |
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preexisting condition. |
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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 that is delivered, issued for delivery, or |
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renewed on or after January 1, 2018. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2018, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 3. This Act takes effect September 1, 2017. |