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  87R5642 MEW-D
 
  By: Hughes S.B. No. 2121
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the deductible imposed by a health benefit plan issuer
  for covered health care services or supplies.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Subtitle A, Title 8, Insurance Code, is amended
  by adding Chapter 1219 to read as follows:
  CHAPTER 1219. DEDUCTIBLE REQUIREMENTS
         Sec. 1219.001.  DEFINITIONS. In this chapter:
               (1)  "Covered health care service or supply" means a
  health care service or supply, including a prescription drug, for
  which the costs are payable, wholly or partly, under the terms of a
  health benefit plan.
               (2)  "Enrollee" means an individual, including a
  dependent, entitled to coverage under a health benefit plan.
               (3)  "Network provider" means any health care provider
  of a health care service or supply with which a health benefit plan
  issuer or administrator or a third party for the issuer or
  administrator has a contract with the terms on which a relevant
  health care service or supply is provided to an enrollee.
               (4)  "Out-of-network provider" means a health care
  provider of any health care service or supply that does not have a
  contract under an enrollee's health benefit plan.
         Sec. 1219.002.  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. 1219.003.  EXCEPTIONS. This chapter does not apply to:
               (1)  a plan that provides coverage:
                     (A)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (B)  as a supplement to a liability insurance
  policy;
                     (C)  for credit insurance;
                     (D)  only for dental or vision care;
                     (E)  only for hospital expenses; or
                     (F)  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(g)(1));
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy; or
               (5)  a long-term care 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 1219.002.
         Sec. 1219.004.  CONFLICT WITH OTHER LAW. If this chapter
  conflicts with another law relating to the imposition of a
  deductible, this chapter controls.
         Sec. 1219.005.  SEPARATE DEDUCTIBLES PROHIBITED. A health
  benefit plan issuer may not impose separate deductibles for covered
  health care services and supplies provided by network providers and
  out-of-network providers. 
         Sec. 1219.006.  COVERED HEALTH CARE SERVICE OR SUPPLY FOR
  PURPOSES OF DEDUCTIBLE. A health benefit plan issuer must include
  as a covered health care service or supply for purposes of an
  enrollee's deductible any amount the enrollee pays:
               (1)  for a health care service delivered as a
  telemedicine medical service or telehealth service, as those terms
  are defined by Section 111.001, Occupations Code; or
               (2)  under a direct primary care arrangement governed
  by Subchapter F, Chapter 162, Occupations Code.
         SECTION 2.  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, 2022. A health benefit plan that is
  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.  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 4.  This Act takes effect September 1, 2021.