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