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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 in this state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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ARTICLE 1. HEALTH BENEFIT AFFORDABILITY AND ACCESSIBILITY |
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SECTION 1.01. Subtitle A, Title 8, Insurance Code, is |
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amended by adding Chapter 1218 to read as follows: |
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CHAPTER 1218. HEALTH BENEFIT AFFORDABILITY AND ACCESSIBILITY |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 1218.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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|
condition, accident, or sickness, including an individual, group, |
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|
blanket, or franchise insurance policy or insurance agreement, a |
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|
group hospital service contract, or an individual or group evidence |
|
|
of coverage or similar coverage document that is issued by: |
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|
(1) an insurance company; |
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|
(2) a group hospital service corporation operating |
|
|
under Chapter 842; |
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|
(3) a health maintenance organization operating under |
|
|
Chapter 843; |
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(4) an approved nonprofit health corporation that |
|
|
holds a certificate of authority under Chapter 844; |
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|
(5) a multiple employer welfare arrangement that holds |
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|
a certificate of authority under Chapter 846; |
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|
(6) a stipulated premium company operating under |
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|
Chapter 884; |
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|
(7) a fraternal benefit society operating under |
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|
Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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|
(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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|
Chapter 1501, including coverage provided through a health group |
|
|
cooperative under Subchapter B of that chapter; |
|
|
(2) a standard health benefit plan issued under |
|
|
Chapter 1507; |
|
|
(3) a basic coverage plan under Chapter 1551; |
|
|
(4) a basic plan under Chapter 1575; |
|
|
(5) a primary care coverage plan under Chapter 1579; |
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|
(6) a plan providing basic coverage under Chapter |
|
|
1601; |
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|
(7) health benefits provided by or through a church |
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|
benefits board under Subchapter I, Chapter 22, Business |
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|
Organizations Code; |
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|
(8) group health coverage made available by a school |
|
|
district in accordance with Section 22.004, Education Code; |
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|
(9) the state Medicaid program, including the Medicaid |
|
|
managed care program operated under Chapter 533, Government Code; |
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|
(10) the child health plan program under Chapter 62, |
|
|
Health and Safety Code; |
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|
(11) a regional or local health care program operated |
|
|
under Section 75.104, Health and Safety Code; |
|
|
(12) a self-funded health benefit plan sponsored by a |
|
|
professional employer organization under Chapter 91, Labor Code; |
|
|
(13) county employee group health benefits provided |
|
|
under Chapter 157, Local Government Code; and |
|
|
(14) health and accident coverage provided by a risk |
|
|
pool created under Chapter 172, Local Government Code. |
|
|
(c) This chapter applies to coverage under a group health |
|
|
benefit plan provided to a resident of this state regardless of |
|
|
whether the group policy, agreement, or contract is delivered, |
|
|
issued for delivery, or renewed in this state. |
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Sec. 1218.002. 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 1218.001. |
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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 |
|
|
increase costs to the individual. |
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Sec. 1218.003. CONFLICT WITH OTHER LAW. If this chapter |
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conflicts with another law relating to lifetime or annual benefit |
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limits or the imposition of a premium, deductible, copayment, |
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coinsurance, or other cost-sharing provision, this chapter |
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controls. |
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SUBCHAPTER B. CERTAIN COST-SHARING AND COVERAGE AMOUNT LIMITS |
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PROHIBITED |
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Sec. 1218.051. CERTAIN COST-SHARING PROVISIONS FOR |
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PREVENTIVE SERVICES PROHIBITED. A health benefit plan issuer may |
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not impose a deductible, copayment, coinsurance, or other |
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|
cost-sharing provision applicable to benefits for: |
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(1) a preventive item or service that has in effect a |
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|
rating of "A" or "B" in the most recent recommendations of the |
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United States Preventive Services Task Force; |
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|
(2) an immunization recommended for routine use in the |
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|
most recent immunization schedules published by the United States |
|
|
Centers for Disease Control and Prevention of the United States |
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Public Health Service; or |
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(3) preventive care and screenings supported by the |
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most recent comprehensive guidelines adopted by the United States |
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Health Resources and Services Administration. |
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Sec. 1218.052. CERTAIN ANNUAL AND LIFETIME LIMITS |
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PROHIBITED. A health benefit plan issuer may not establish an |
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annual or lifetime benefit amount for an enrollee in relation to |
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|
essential health benefits listed in 42 U.S.C. Section 18022(b)(1), |
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|
as that section existed on January 1, 2017, and other benefits |
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|
identified by the United States secretary of health and human |
|
|
services as essential health benefits as of that date. |
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Sec. 1218.053. LIMITATIONS ON COST-SHARING. A health |
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|
benefit plan issuer may not impose cost-sharing requirements that |
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exceed the limits established in 42 U.S.C. Section 18022(c)(1) in |
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|
relation to essential health benefits listed in 42 U.S.C. Section |
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18022(b)(1), as those sections existed on January 1, 2017, and |
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|
other benefits identified by the United States secretary of health |
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and human services as essential health benefits as of that date. |
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Sec. 1218.054. DISCRIMINATION BASED ON GENDER PROHIBITED. |
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A health benefit plan issuer may not charge an individual a higher |
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premium rate based on the individual's gender. |
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SUBCHAPTER C. COVERAGE OF PREEXISTING CONDITIONS |
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Sec. 1218.101. DEFINITION. In this subchapter, |
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"preexisting condition" means a condition present before the |
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effective date of an individual's coverage under a health benefit |
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|
plan. |
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Sec. 1218.102. 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 |
|
|
refuse to enroll an individual in a health benefit plan due to a |
|
|
preexisting condition; |
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|
(2) limit or exclude coverage under the health benefit |
|
|
plan for the treatment of a preexisting condition otherwise covered |
|
|
under the plan; or |
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(3) charge the individual more for coverage than the |
|
|
health benefit plan issuer charges an individual who does not have a |
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|
preexisting condition. |
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SUBCHAPTER D. EXTERNAL REVIEW PROCEDURE |
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Sec. 1218.151. EXTERNAL REVIEW MODEL ACT RULES. (a) The |
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department shall adopt rules as necessary to conform Texas law with |
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|
the requirements of the NAIC Uniform Health Carrier External Review |
|
|
Model Act (April 2010). |
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(b) To the extent that the rules adopted under this section |
|
|
conflict with Chapter 843 or Title 14, the rules control. |
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ARTICLE 2. HEALTH BENEFIT PLAN COVERAGE FOR MENTAL HEALTH |
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|
CONDITIONS AND SUBSTANCE USE DISORDERS |
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|
SECTION 2.01. Chapter 1355, Insurance Code, is amended by |
|
|
adding Subchapter F to read as follows: |
|
|
SUBCHAPTER F. COVERAGE FOR MENTAL HEALTH CONDITIONS AND SUBSTANCE |
|
|
USE DISORDERS |
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|
Sec. 1355.251. DEFINITIONS. In this subchapter: |
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|
(1) "Financial requirement" includes a requirement |
|
|
relating to a deductible, copayment, coinsurance, or other |
|
|
out-of-pocket expense or an annual or lifetime limit. |
|
|
(2) "Mental health benefit" means a benefit relating |
|
|
to an item or service for a mental health condition, as defined |
|
|
under the terms of a health benefit plan and in accordance with |
|
|
applicable federal and state law. |
|
|
(3) "Nonquantitative treatment limitation" includes: |
|
|
(A) a medical management standard limiting or |
|
|
excluding benefits based on medical necessity or medical |
|
|
appropriateness or based on whether a treatment is experimental or |
|
|
investigational; |
|
|
(B) formulary design for prescription drugs; |
|
|
(C) network tier design; |
|
|
(D) a standard for provider participation in a |
|
|
network, including reimbursement rates; |
|
|
(E) a method used by a health benefit plan to |
|
|
determine usual, customary, and reasonable charges; |
|
|
(F) a step therapy protocol; |
|
|
(G) an exclusion based on failure to complete a |
|
|
course of treatment; and |
|
|
(H) a restriction based on geographic location, |
|
|
facility type, provider specialty, and other criteria that limit |
|
|
the scope or duration of a benefit. |
|
|
(4) "Substance use disorder benefit" means a benefit |
|
|
relating to an item or service for a substance use disorder, as |
|
|
defined under the terms of a health benefit plan and in accordance |
|
|
with applicable federal and state law. |
|
|
(5) "Treatment limitation" includes a limit on the |
|
|
frequency of treatment, number of visits, days of coverage, or |
|
|
other similar limit on the scope or duration of treatment. The term |
|
|
includes a nonquantitative treatment limitation. |
|
|
Sec. 1355.252. APPLICABILITY OF SUBCHAPTER. (a) This |
|
|
subchapter 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 |
|
|
issued by: |
|
|
(1) an insurance company; |
|
|
(2) a group hospital service corporation operating |
|
|
under Chapter 842; |
|
|
(3) a health maintenance organization operating under |
|
|
Chapter 843; |
|
|
(4) an approved nonprofit health corporation that |
|
|
holds a certificate of authority under Chapter 844; |
|
|
(5) a multiple employer welfare arrangement that holds |
|
|
a certificate of authority under Chapter 846; |
|
|
(6) a stipulated premium company operating under |
|
|
Chapter 884; |
|
|
(7) a fraternal benefit society operating under |
|
|
Chapter 885; |
|
|
(8) a Lloyd's plan operating under Chapter 941; or |
|
|
(9) an exchange operating under Chapter 942. |
|
|
(b) Notwithstanding any other law, this subchapter applies |
|
|
to: |
|
|
(1) a small employer health benefit plan subject to |
|
|
Chapter 1501, including coverage provided through a health group |
|
|
cooperative under Subchapter B of that chapter; |
|
|
(2) a standard health benefit plan issued under |
|
|
Chapter 1507; |
|
|
(3) a basic coverage plan under Chapter 1551; |
|
|
(4) a basic plan under Chapter 1575; |
|
|
(5) a primary care coverage plan under Chapter 1579; |
|
|
(6) a plan providing basic coverage under Chapter |
|
|
1601; |
|
|
(7) health benefits provided by or through a church |
|
|
benefits board under Subchapter I, Chapter 22, Business |
|
|
Organizations Code; |
|
|
(8) group health coverage made available by a school |
|
|
district in accordance with Section 22.004, Education Code; |
|
|
(9) the state Medicaid program, including the Medicaid |
|
|
managed care program operated under Chapter 533, Government Code; |
|
|
(10) the child health plan program under Chapter 62, |
|
|
Health and Safety Code; |
|
|
(11) a regional or local health care program operated |
|
|
under Section 75.104, Health and Safety Code; |
|
|
(12) a self-funded health benefit plan sponsored by a |
|
|
professional employer organization under Chapter 91, Labor Code; |
|
|
(13) county employee group health benefits provided |
|
|
under Chapter 157, Local Government Code; and |
|
|
(14) health and accident coverage provided by a risk |
|
|
pool created under Chapter 172, Local Government Code. |
|
|
(c) This subchapter applies to coverage under a group health |
|
|
benefit plan provided to a resident of this state regardless of |
|
|
whether the group policy, agreement, or contract is delivered, |
|
|
issued for delivery, or renewed in this state. |
|
|
Sec. 1355.253. EXCEPTION. This subchapter does not apply |
|
|
to an individual health benefit plan issued on or before March 23, |
|
|
2010, that has not had any significant changes since that date that |
|
|
reduce benefits or increase costs to the individual. |
|
|
Sec. 1355.254. REQUIRED COVERAGE FOR MENTAL HEALTH |
|
|
CONDITIONS AND SUBSTANCE USE DISORDERS. (a) A health benefit plan |
|
|
must provide benefits for mental health conditions and substance |
|
|
use disorders under the same terms and conditions applicable to |
|
|
benefits for medical or surgical expenses. |
|
|
(b) Coverage under Subsection (a) may not impose treatment |
|
|
limitations or financial requirements on benefits for a mental |
|
|
health condition or substance use disorder that are generally more |
|
|
restrictive than treatment limitations or financial requirements |
|
|
imposed on coverage of benefits for medical or surgical expenses. |
|
|
Sec. 1355.255. DEFINITIONS UNDER PLAN. (a) A health |
|
|
benefit plan must define a condition to be a mental health condition |
|
|
or not a mental health condition in a manner consistent with |
|
|
generally recognized independent standards of medical practice. |
|
|
(b) A health benefit plan must define a condition to be a |
|
|
substance use disorder or not a substance use disorder in a manner |
|
|
consistent with generally recognized independent standards of |
|
|
medical practice. |
|
|
Sec. 1355.256. COORDINATION WITH OTHER LAW; INTENT OF |
|
|
LEGISLATURE. This subchapter supplements Subchapters A and B of |
|
|
this chapter and Chapter 1368 and the department rules adopted |
|
|
under those statutes. It is the intent of the legislature that |
|
|
Subchapter A or B of this chapter or Chapter 1368 or the department |
|
|
rules adopted under those statutes controls in any circumstance in |
|
|
which that other law requires: |
|
|
(1) a benefit that is not required by this subchapter; |
|
|
or |
|
|
(2) a more extensive benefit than is required by this |
|
|
subchapter. |
|
|
Sec. 1355.257. RULES. The commissioner shall adopt rules |
|
|
necessary to implement this subchapter. |
|
|
ARTICLE 3. COVERAGE OF ESSENTIAL HEALTH BENEFITS |
|
|
SECTION 3.01. Subtitle E, Title 8, Insurance Code, is |
|
|
amended by adding Chapter 1380 to read as follows: |
|
|
CHAPTER 1380. COVERAGE OF ESSENTIAL HEALTH BENEFITS |
|
|
Sec. 1380.001. 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 issued by: |
|
|
(1) an insurance company; |
|
|
(2) a group hospital service corporation operating |
|
|
under Chapter 842; |
|
|
(3) a health maintenance organization operating under |
|
|
Chapter 843; |
|
|
(4) an approved nonprofit health corporation that |
|
|
holds a certificate of authority under Chapter 844; |
|
|
(5) a multiple employer welfare arrangement that holds |
|
|
a certificate of authority under Chapter 846; |
|
|
(6) a stipulated premium company operating under |
|
|
Chapter 884; |
|
|
(7) a fraternal benefit society operating under |
|
|
Chapter 885; |
|
|
(8) a Lloyd's plan operating under Chapter 941; or |
|
|
(9) an exchange operating under Chapter 942. |
|
|
(b) Notwithstanding any other law, this chapter applies to: |
|
|
(1) a small employer health benefit plan subject to |
|
|
Chapter 1501, including coverage provided through a health group |
|
|
cooperative under Subchapter B of that chapter; |
|
|
(2) a standard health benefit plan issued under |
|
|
Chapter 1507; |
|
|
(3) a basic coverage plan under Chapter 1551; |
|
|
(4) a basic plan under Chapter 1575; |
|
|
(5) a primary care coverage plan under Chapter 1579; |
|
|
(6) a plan providing basic coverage under Chapter |
|
|
1601; |
|
|
(7) health benefits provided by or through a church |
|
|
benefits board under Subchapter I, Chapter 22, Business |
|
|
Organizations Code; |
|
|
(8) group health coverage made available by a school |
|
|
district in accordance with Section 22.004, Education Code; |
|
|
(9) the state Medicaid program, including the Medicaid |
|
|
managed care program operated under Chapter 533, Government Code; |
|
|
(10) the child health plan program under Chapter 62, |
|
|
Health and Safety Code; |
|
|
(11) a regional or local health care program operated |
|
|
under Section 75.104, Health and Safety Code; |
|
|
(12) a self-funded health benefit plan sponsored by a |
|
|
professional employer organization under Chapter 91, Labor Code; |
|
|
(13) county employee group health benefits provided |
|
|
under Chapter 157, Local Government Code; and |
|
|
(14) health and accident coverage provided by a risk |
|
|
pool created under Chapter 172, Local Government Code. |
|
|
(c) This chapter applies to coverage under a group health |
|
|
benefit plan provided to a resident of this state regardless of |
|
|
whether the group policy, agreement, or contract is delivered, |
|
|
issued for delivery, or renewed in this state. |
|
|
Sec. 1380.002. EXCEPTION. This chapter does not apply to an |
|
|
individual health benefit plan issued on or before March 23, 2010, |
|
|
that has not had any significant changes since that date that reduce |
|
|
benefits or increase costs to the individual. |
|
|
Sec. 1380.003. REQUIRED COVERAGE FOR ESSENTIAL HEALTH |
|
|
BENEFITS. A health benefit plan must provide coverage for the |
|
|
essential health benefits listed in 42 U.S.C. Section 18022(b)(1), |
|
|
as that section existed on January 1, 2017, and other benefits |
|
|
identified by the United States secretary of health and human |
|
|
services as essential health benefits as of that date. |
|
|
ARTICLE 4. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN YOUNG ADULTS |
|
|
SECTION 4.01. Subchapter A, Chapter 533, Government Code, |
|
|
is amended by adding Section 533.0054 to read as follows: |
|
|
Sec. 533.0054. ELIGIBILITY AGE FOR STAR HEALTH COVERAGE. A |
|
|
child enrolled in the STAR Health Medicaid managed care program is |
|
|
eligible to receive health care services under the program until |
|
|
the child is 26 years of age. |
|
|
SECTION 4.02. Section 846.260, Insurance Code, is amended |
|
|
to read as follows: |
|
|
Sec. 846.260. LIMITING AGE APPLICABLE TO UNMARRIED CHILD. |
|
|
If children are eligible for coverage under the terms of a multiple |
|
|
employer welfare arrangement's plan document, any limiting age |
|
|
applicable to an unmarried child of an enrollee is 26 [25] years of |
|
|
age. |
|
|
SECTION 4.03. Section 1201.053(b), Insurance Code, as |
|
|
effective until September 1, 2018, 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 a spouse, |
|
|
unmarried children younger than 26 [25] years of age, including a |
|
|
grandchild of the adult as described by Section 1201.062(a)(1), 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 any other individual dependent on the adult. |
|
|
SECTION 4.04. Section 1201.053(b), Insurance Code, as |
|
|
effective September 1, 2018, 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 a spouse, |
|
|
unmarried children younger than 26 [25] years of age, including a |
|
|
grandchild of the adult as described by Section 1201.062(a)(1), a |
|
|
child the adult is required to insure under a medical support order |
|
|
or dental support order, if the policy provides dental coverage, |
|
|
issued under Chapter 154, Family Code, or enforceable by a court in |
|
|
this state, and any other individual dependent on the adult. |
|
|
SECTION 4.05. Section 1201.062(a), Insurance Code, as |
|
|
effective until September 1, 2018, 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, that provides coverage for |
|
|
a child of an insured or group member, on payment of a premium, must |
|
|
provide coverage for: |
|
|
(1) each grandchild of the insured or group member if |
|
|
the grandchild is: |
|
|
(A) unmarried; |
|
|
(B) younger than 26 [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 4.06. Section 1201.062(a), Insurance Code, as |
|
|
effective September 1, 2018, 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, that provides coverage for |
|
|
a child of an insured or group member, on payment of a premium, must |
|
|
provide coverage for: |
|
|
(1) each grandchild of the insured or group member if |
|
|
the grandchild is: |
|
|
(A) unmarried; |
|
|
(B) younger than 26 [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 or dental support, if the policy |
|
|
provides dental coverage, under an order issued under Chapter 154, |
|
|
Family Code, or enforceable by a court in this state. |
|
|
SECTION 4.07. Section 1201.065(a), Insurance Code, is |
|
|
amended to read as follows: |
|
|
(a) An individual or group accident and health insurance |
|
|
policy may contain criteria relating to a maximum age or enrollment |
|
|
in school to establish continued eligibility for coverage of a |
|
|
child 26 [25] years of age or older. |
|
|
SECTION 4.08. 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 26 [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 4.09. Section 1251.152(a), Insurance Code, is |
|
|
amended to read as follows: |
|
|
(a) For purposes of this section, "dependent" includes: |
|
|
(1) a child of an employee or member who is: |
|
|
(A) unmarried; and |
|
|
(B) younger than 26 [25] years of age; and |
|
|
(2) a grandchild of an employee or member who is: |
|
|
(A) unmarried; |
|
|
(B) younger than 26 [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. |
|
|
SECTION 4.10. Section 1271.006(a), Insurance Code, is |
|
|
amended to read as follows: |
|
|
(a) If children are eligible for coverage under the terms of |
|
|
an evidence of coverage, any limiting age applicable to an |
|
|
unmarried child of an enrollee, including an unmarried grandchild |
|
|
of an enrollee, is 26 [25] years of age. The limiting age |
|
|
applicable to a child must be stated in the evidence of coverage. |
|
|
SECTION 4.11. Section 1501.002(2), Insurance Code, is |
|
|
amended to read as follows: |
|
|
(2) "Dependent" means: |
|
|
(A) a spouse; |
|
|
(B) a child younger than 26 [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 |
|
|
(E) any other child eligible under an employer's |
|
|
health benefit plan, including a child described by Section |
|
|
1503.003. |
|
|
SECTION 4.12. Section 1501.609(b), Insurance Code, is |
|
|
amended to read as follows: |
|
|
(b) Any limiting age applicable under a large employer |
|
|
health benefit plan to an unmarried child of an enrollee is 26 [25] |
|
|
years of age. |
|
|
SECTION 4.13. Sections 1503.003(a) and (b), Insurance Code, |
|
|
are amended to read as follows: |
|
|
(a) A health benefit plan may not condition coverage for a |
|
|
child younger than 26 [25] years of age on the child's being |
|
|
enrolled at an educational institution. |
|
|
(b) A health benefit plan that requires as a condition of |
|
|
coverage for a child 26 [25] years of age or older that the child be |
|
|
a full-time student at an educational institution must provide the |
|
|
coverage: |
|
|
(1) for the entire academic term during which the |
|
|
child begins as a full-time student and remains enrolled, |
|
|
regardless of whether the number of hours of instruction for which |
|
|
the child is enrolled is reduced to a level that changes the child's |
|
|
academic status to less than that of a full-time student; and |
|
|
(2) continuously until the 10th day of instruction of |
|
|
the subsequent academic term, on which date the health benefit plan |
|
|
may terminate coverage for the child if the child does not return to |
|
|
full-time student status before that date. |
|
|
SECTION 4.14. 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; |
|
|
(2) unmarried child younger than 26 [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 has |
|
|
a mental disability or 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. |
|
|
ARTICLE 5. TRANSITION; EFFECTIVE DATE |
|
|
SECTION 5.01. 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, 2018. A health benefit |
|
|
plan that is delivered, issued for delivery, or renewed before |
|
|
January 1, 2018, 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 5.02. If before implementing any provision of this |
|
|
Act a state agency determines that a waiver or authorization from a |
|
|
federal agency is necessary for implementation of that provision, |
|
|
the agency affected by the provision shall request the waiver or |
|
|
authorization and may delay implementing that provision until the |
|
|
waiver or authorization is granted. |
|
|
SECTION 5.03. This Act takes effect September 1, 2017. |