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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit coverage for hearing aids for children |
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and adults. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1365, Insurance Code, is amended by |
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designating Sections 1365.001 through 1365.004 as Subchapter A and |
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adding a subchapter heading to read as follows: |
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SUBCHAPTER A. GENERAL PROVISIONS |
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SECTION 2. Sections 1365.001 and 1365.002, Insurance Code, |
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are amended to read as follows: |
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Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This |
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subchapter [chapter] applies only to a group health benefit plan |
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that provides hospital and medical coverage on an expense-incurred, |
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service, or prepaid basis, including a group policy, contract, or |
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plan that is offered in this state by: |
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(1) an insurer; |
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(2) a group hospital service corporation operating |
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under Chapter 842; or |
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(3) a health maintenance organization operating under |
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Chapter 843. |
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Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
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LAW. The provisions of Chapter 1201, including provisions relating |
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to the applicability, purpose, and enforcement of that chapter, |
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construction of policies under that chapter, rulemaking under that |
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chapter, and definitions of terms applicable in that chapter, apply |
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to this subchapter [chapter]. |
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SECTION 3. Chapter 1365, Insurance Code, is amended by |
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adding Subchapter B to read as follows: |
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SUBCHAPTER B. HEARING AID COVERAGE |
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Sec. 1365.051. APPLICABILITY. (a) This subchapter applies |
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only to a health benefit plan, including a small employer health |
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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 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, 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 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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(d) Notwithstanding Section 22.409, Business Organizations |
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Code, or any other law, this subchapter 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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(e) 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 operated under that section. |
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(f) 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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(g) 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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Sec. 1365.052. EXCEPTION. (a) This subchapter does not |
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apply 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; or |
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(6) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code. |
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(b) This subchapter does not apply to a qualified health |
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plan defined by 45 C.F.R. Section 155.20 if a determination is made |
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under 45 C.F.R. Section 155.170 that: |
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(1) this subchapter requires the plan to offer |
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benefits in addition to the essential health benefits required |
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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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Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit |
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plan that provides coverage for hearing aids may not deny an |
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enrollee's claim for a hearing aid solely on the basis that the |
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price of the hearing aid is more than the benefit available under |
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the health benefit plan. |
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(b) Notwithstanding Section 1367.253(d), this section |
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applies to a health benefit plan subject to Subchapter F, Chapter |
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1367. |
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(c) Nothing in this section requires a health benefit plan |
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to pay an enrollee's claim for a hearing aid in an amount that is |
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more than the benefit available under the health benefit plan. |
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SECTION 4. This Act applies only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2022. |
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SECTION 5. This Act takes effect September 1, 2021. |