88R3711 MEW-D
 
  By: Zaffirini S.B. No. 51
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit coverage for hearing aids for children
  and adults.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1365, Insurance Code, is amended by
  designating Sections 1365.001 through 1365.004 as Subchapter A and
  adding a subchapter heading to read as follows:
  SUBCHAPTER A. GENERAL PROVISIONS
         SECTION 2.  Sections 1365.001 and 1365.002, Insurance Code,
  are amended to read as follows:
         Sec. 1365.001.  APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
  subchapter [chapter] applies only to a group health benefit plan
  that provides hospital and medical coverage on an expense-incurred,
  service, or prepaid basis, including a group policy, contract, or
  plan that is offered in this state by:
               (1)  an insurer;
               (2)  a group hospital service corporation operating
  under Chapter 842; or
               (3)  a health maintenance organization operating under
  Chapter 843.
         Sec. 1365.002.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER
  LAW. The provisions of Chapter 1201, including provisions relating
  to the applicability, purpose, and enforcement of that chapter,
  construction of policies under that chapter, rulemaking under that
  chapter, and definitions of terms applicable in that chapter, apply
  to this subchapter [chapter].
         SECTION 3.  Chapter 1365, Insurance Code, is amended by
  adding Subchapter B to read as follows:
  SUBCHAPTER B. HEARING AID COVERAGE
         Sec. 1365.051.  APPLICABILITY. (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 offered 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)  This subchapter applies to coverage under a group health
  benefit plan described by Subsection (a) provided to a resident of
  this state, regardless of whether the group policy, agreement, or
  contract is delivered, issued for delivery, or renewed within or
  outside this state.
         (c)  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)  a regional or local health care program operated
  under Section 75.104, Health and Safety Code; and
               (9)  a self-funded health benefit plan sponsored by a
  professional employer organization under Chapter 91, Labor Code.
         Sec. 1365.052.  EXCEPTION. This subchapter 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; or
                     (B)  only for hospital expenses; or
               (2)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapter 533, Government Code.
         Sec. 1365.053.  CHOICE OF HEARING AID. (a) A health benefit
  plan that provides coverage for hearing aids may not deny an
  enrollee's claim for a hearing aid solely on the basis that the
  price of the hearing aid is more than the benefit available under
  the health benefit plan.
         (b)  Notwithstanding Section 1367.253(d), this section
  applies to a health benefit plan subject to Subchapter F, Chapter
  1367.
         (c)  Nothing in this section requires a health benefit plan
  to pay an enrollee's claim for a hearing aid in an amount that is
  more than the benefit available under the health benefit plan.
         SECTION 4.  This Act applies only to a health benefit plan
  that is delivered, issued for delivery, or renewed on or after
  January 1, 2024.
         SECTION 5.  This Act takes effect September 1, 2023.