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A BILL TO BE ENTITLED
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AN ACT
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relating to the definition of state-mandated health benefits for |
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the purposes of consumer choice of benefits plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1507.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1507.003. STATE-MANDATED HEALTH BENEFITS. (a) For |
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purposes of this subchapter, "state-mandated health benefits" |
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means coverage or another feature required under this code or other |
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laws of this state to be provided in an individual, blanket, or |
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group policy for accident and health insurance or a contract for a |
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health-related condition that: |
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(1) includes coverage for specific health care |
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services or benefits; |
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(2) places limitations or restrictions on |
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deductibles, coinsurance, copayments, or any annual or lifetime |
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maximum benefit amounts; [or] |
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(3) includes a specific category of licensed health |
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care practitioner from whom an insured is entitled to receive care; |
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(4) requires standard provisions or rights that are |
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unrelated to a specific health illness, injury, or condition of an |
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insured; or |
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(5) requires the policy or contract to exceed federal |
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requirements. |
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(b) For purposes of this subchapter, "state-mandated health |
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benefits" does not include benefits that are mandated by federal |
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law or standard provisions or rights required under this code or |
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other laws of this state to be provided in an individual, blanket, |
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or group policy for accident and health insurance if those standard |
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provisions or rights are also required to be provided in a basic |
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coverage plan under Chapter 1551 [that are unrelated to a specific |
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health illness, injury, or condition of an insured, including |
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provisions related to: |
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[(1) continuation of coverage under: |
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[(A) Subchapters F and G, Chapter 1251; |
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[(B) Section 1201.059; and |
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[(C) Subchapter B, Chapter 1253; |
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[(2) termination of coverage under Sections 1202.051 |
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and 1501.108; |
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[(3) preexisting conditions under Subchapter D, |
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Chapter 1201, and Sections 1501.102-1501.105; |
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[(4) coverage of children, including newborn or |
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adopted children, under: |
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[(A) Subchapter D, Chapter 1251; |
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[(B) Sections 1201.053, 1201.061, |
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1201.063-1201.065, and Subchapter A, Chapter 1367; |
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[(C) Chapter 1504; |
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[(D) Chapter 1503; |
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[(E) Section 1501.157; |
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[(F) Section 1501.158; and |
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[(G) Sections 1501.607-1501.609; |
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[(5) services of practitioners under: |
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[(A) Subchapters A, B, and C, Chapter 1451; or |
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[(B) Section 1301.052; |
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[(6) supplies and services associated with the |
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treatment of diabetes under Subchapter B, Chapter 1358; |
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[(7) coverage for serious mental illness under |
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Subchapter A, Chapter 1355; |
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[(8) coverage for childhood immunizations and hearing |
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screening as required by Subchapters B and C, Chapter 1367, other |
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than Section 1367.053(c) and Chapter 1353; |
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[(9) coverage for reconstructive surgery for certain |
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craniofacial abnormalities of children as required by Subchapter D, |
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Chapter 1367; |
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[(10) coverage for the dietary treatment of |
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phenylketonuria as required by Chapter 1359; |
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[(11) coverage for referral to a non-network physician |
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or provider when medically necessary covered services are not |
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available through network physicians or providers, as required by |
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Section 1271.055; and |
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[(12) coverage for cancer screenings under: |
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[(A) Chapter 1356; |
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[(B) Chapter 1362; |
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[(C) Chapter 1363; and |
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[(D) Chapter 1370]. |
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SECTION 2. Section 1507.053, Insurance Code, is amended to |
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read as follows: |
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Sec. 1507.053. STATE-MANDATED HEALTH BENEFITS. (a) For |
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purposes of this subchapter, "state-mandated health benefits" |
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means coverage or another feature required under this code or other |
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laws of this state to be provided in an evidence of coverage that: |
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(1) includes coverage for specific health care |
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services or benefits; |
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(2) places limitations or restrictions on |
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deductibles, coinsurance, copayments, or any annual or lifetime |
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maximum benefit amounts, including limitations provided in Section |
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1271.151; [or] |
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(3) includes a specific category of licensed health |
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care practitioner from whom an enrollee is entitled to receive |
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care; |
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(4) requires standard provisions or rights that are |
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unrelated to a specific health illness, injury, or condition of an |
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enrollee; or |
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(5) requires the evidence of coverage to exceed |
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federal requirements. |
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(b) For purposes of this subchapter, "state-mandated health |
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benefits" does not include coverage that is mandated by federal law |
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or standard provisions or rights required under this code or other |
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laws of this state to be provided in an evidence of coverage if |
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those standard provisions or rights are also required to be |
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provided in a basic coverage plan under Chapter 1551 [that are |
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unrelated to a specific health illness, injury, or condition of an |
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enrollee, including provisions related to: |
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[(1) continuation of coverage under Subchapter G, |
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Chapter 1251; |
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[(2) termination of coverage under Sections 1202.051 |
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and 1501.108; |
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[(3) preexisting conditions under Subchapter D, |
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Chapter 1201, and Sections 1501.102-1501.105; |
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[(4) coverage of children, including newborn or |
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adopted children, under: |
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[(A) Chapter 1504; |
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[(B) Chapter 1503; |
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[(C) Section 1501.157; |
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[(D) Section 1501.158; and |
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[(E) Sections 1501.607-1501.609; |
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[(5) services of providers under Section 843.304; |
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[(6) coverage for serious mental health illness under |
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Subchapter A, Chapter 1355; and |
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[(7) coverage for cancer screenings under: |
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[(A) Chapter 1356; |
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[(B) Chapter 1362; |
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[(C) Chapter 1363; and |
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[(D) Chapter 1370]. |
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SECTION 3. The changes in law made by this Act apply only to |
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a standard health benefit plan delivered, issued for delivery, or |
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renewed under Chapter 1507, Insurance Code, on or after January 1, |
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2024. A standard health benefit plan delivered, issued for |
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delivery, or renewed under Chapter 1507, Insurance Code, before |
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January 1, 2024, is governed by the law as it existed immediately |
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before the effective date of this Act, and that law is continued in |
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effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2023. |