88R2521 CJD-F
 
  By: Hughes S.B. No. 861
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to coordination of vision and eye care benefits under
  certain insurance policies and vision plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1203, Insurance Code, is amended by
  adding Subchapter C to read as follows:
  SUBCHAPTER C. VISION AND EYE CARE BENEFITS
         Sec. 1203.101.  DEFINITIONS. In this subchapter:
               (1)  "Benefit plan" means an insurance policy, vision
  benefit plan, or vision discount plan described by Section
  1203.102.
               (2)  "Benefit plan provider" means an insurer or other
  person or entity described by Section 1203.102 that issues or
  provides a benefit plan.
               (3)  "Eye care expenses" means expenses related to
  vision or medical eye care services, procedures, or products.
         Sec. 1203.102.  APPLICABILITY OF SUBCHAPTER. This
  subchapter applies only to an insurance policy, vision benefit
  plan, or vision discount plan that provides or arranges for
  benefits for vision or medical eye care services, procedures, or
  products, including an individual, group, blanket, or franchise
  insurance policy or insurance agreement, a group hospital service
  contract, a vision benefit plan, or a vision discount plan offered
  by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a stipulated premium company operating under
  Chapter 884;
               (4)  a fraternal benefit society operating under
  Chapter 885;
               (5)  a Lloyd's plan operating under Chapter 941;
               (6)  an exchange operating under Chapter 942; or
               (7)  a person or entity that provides a vision benefit
  or vision discount plan.
         Sec. 1203.103.  COORDINATION OF BENEFITS BETWEEN MULTIPLE
  PLANS.  (a)  This section applies if a benefit plan enrollee is
  covered by at least two different benefit plans that provide
  benefits for eye care expenses.
         (b)  The benefit plan provider to whom a claim for
  reimbursement for eye care expenses is initially submitted shall
  reimburse for all eye care expenses covered under the plan up to the
  full amount of any coverage limit applicable to the covered eye care
  expenses.
         (c)  A benefit plan provider to whom a claim for
  reimbursement for eye care expenses is subsequently submitted shall
  reimburse for all eye care expenses covered under the plan that are
  not reimbursed by a benefit plan provider to whom a claim for
  reimbursement was previously submitted.
         (d)  Each benefit plan provider shall provide a summary of
  eye care expenses accepted and denied under the plan to the enrollee
  and the practitioner who provided the eye care services.  The
  summary must be accessible online to the enrollee and the
  practitioner.
         Sec. 1203.104.  CERTAIN COORDINATION OF BENEFITS PROVISIONS
  PROHIBITED.  A benefit plan may not be delivered, issued for
  delivery, or renewed in this state if:
               (1)  a provision of the plan excludes or reduces the
  payment of benefits for eye care expenses to or on behalf of an
  enrollee;
               (2)  the reason for the exclusion or reduction is that
  eye care benefits are payable or have been paid to or on behalf of
  the enrollee under another benefit plan; and
               (3)  the exclusion or reduction would apply before the
  full amount of the eye care expenses incurred by the enrollee and
  covered by both plans have been paid or reimbursed or the full
  amount of the applicable coverage limit of the plan containing the
  exclusion or reduction is reached.
         Sec. 1203.105.  CERTAIN COORDINATION OF BENEFITS PROVISIONS
  VOID. A provision of a benefit plan that violates this subchapter
  is void.
         SECTION 2.  The change in law made by this Act applies only
  to an insurance policy, vision benefit plan, or vision discount
  plan that is delivered, issued for delivery, or renewed on or after
  January 1, 2024.  A policy or plan delivered, issued for delivery,
  or renewed before January 1, 2024, 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, 2023.