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A BILL TO BE ENTITLED
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AN ACT
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relating to the applicability of certain provisions mandating the |
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provision by certain health benefit plans of health benefits |
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requiring cost defrayal by this state. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1425, Insurance Code, is amended by |
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adding Subchapter A, and a heading is added to that subchapter to |
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read as follows: |
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SUBCHAPTER A. EXCEPTED BENEFITS |
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SECTION 2. Sections 1425.001 and 1425.002, Insurance Code, |
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are transferred to Subchapter A, Chapter 1425, Insurance Code, as |
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added by this Act. |
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SECTION 3. Chapter 1425, Insurance Code, is amended by |
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adding Subchapter B to read as follows: |
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SUBCHAPTER B. BENEFITS REQUIRING DEFRAYAL |
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Sec. 1425.051. DEFINITION. In this subchapter, "qualified |
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health plan" has the meaning assigned by 45 C.F.R. Section 155.20. |
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Sec. 1425.052. EXEMPTION FROM SUBTITLE FOR BENEFITS |
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REQUIRING DEFRAYAL. (a) A provision of this subtitle that is |
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enacted on or after January 1, 2012, does not apply to a qualified |
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health plan if a determination is made under 45 C.F.R. Section |
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155.170 that: |
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(1) the provision 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 the provision. |
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(b) If a determination described by Subsection (a) is made |
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as to a qualified health plan, the provision to which the |
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determination relates does not apply to a non-qualified health plan |
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if the non-qualified health plan is offered in the same market as |
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the qualified health plan. |
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SECTION 4. This Act takes effect immediately if it receives |
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a vote of two-thirds of all the members elected to each house, as |
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provided by Section 39, Article III, Texas Constitution. If this |
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Act does not receive the vote necessary for immediate effect, this |
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Act takes effect September 1, 2021. |