87R464 SMT-D
  By: Thierry H.B. No. 1667
  relating to a limit on cost-sharing requirements imposed by a
  health benefit plan for certain prescription insulin.
         SECTION 1.  Chapter 1358, Insurance Code, is amended by
  adding Subchapter C to read as follows:
         Sec. 1358.101.  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 a small or large
  employer group contract 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 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 subchapter applies to group health coverage made
  available by a school district in accordance with Section 22.004,
  Education Code.
         (c)  Notwithstanding any provision in Chapter 1551, 1575,
  1579, or 1601 or any other law, this subchapter 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;
               (4)  basic coverage under Chapter 1601.
         (d)  Notwithstanding any other law, this subchapter applies
  to coverage under:
               (1)  the child health plan program under Chapter 62,
  Health and Safety Code, or the health benefits plan for children
  under Chapter 63, Health and Safety Code; and
               (2)  the medical assistance program under Chapter 32,
  Human Resources Code.
         Sec. 1358.102.  EXCEPTION. This subchapter does not apply
               (1)  a health benefit plan that provides coverage:
                     (A)  only for a specified disease or for another
  single benefit;
                     (B)  only for accidental death or dismemberment;
                     (C)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (D)  as a supplement to a liability insurance
                     (E)  for credit insurance;
                     (F)  only for dental or vision care;
                     (G)  only for hospital expenses; or
                     (H)  only for indemnity for hospital confinement;
               (2)  a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
               (3)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (4)  a long-term care insurance 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 1358.101;
               (5)  health and accident coverage provided by a risk
  pool created under Chapter 172, Local Government Code; or
               (6)  a workers' compensation insurance policy.
         Sec. 1358.103.  LIMIT ON COST-SHARING REQUIREMENT. (a) In
  this section, "insulin" means a prescription drug that contains
  insulin and is used to treat diabetes. The term does not include an
  insulin drug that is administered to a patient intravenously.
         (b)  Subject to Subsection (c), a health benefit plan may not
  impose a cost-sharing provision for insulin if the total amount the
  enrollee is required to pay exceeds $100 for a 30-day supply. 
         (c)  On January 1 of each year, the limit on the amount that
  an enrollee may be required to pay for a 30-day supply of insulin
  increases by a percentage equal to any percentage increase from the
  preceding year in the medical care component of the Consumer Price
  Index of the Bureau of Labor Statistics of the United States
  Department of Labor. 
         (c-1)  Subsection (c) takes effect January 1, 2023. This
  subsection expires September 1, 2023.
         SECTION 2.  The changes in law made by this Act apply only to
  a health benefit plan that is delivered, issued for delivery, or
  renewed on or after January 1, 2022. A health benefit plan
  delivered, issued for delivery, or renewed before January 1, 2022,
  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, 2021.