Texas 2009 - 81st Regular

Texas House Bill HB2975 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	81R10199 PB-D
2	2	By: Coleman H.B. No. 2975
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for certain physical
8	8	injuries that are self-inflicted by a minor.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1373 to read as follows:
12	12	CHAPTER 1373. COVERAGE FOR CERTAIN SELF-INFLICTED
13	13	PHYSICAL INJURIES BY MINORS
14	14	Sec. 1373.001. DEFINITIONS. In this chapter:
15	15	(1) "Enrollee" means an individual entitled to
16	16	coverage under a health benefit plan.
17	17	(2) "Serious mental illness" has the meaning assigned
18	18	by Section 1355.001 and also includes a diagnosable behavioral or
19	19	emotional disorder or a neuropsychiatric condition:
20	20	(A) that results in a serious disability
21	21	requiring sustained treatment interventions;
22	22	(B) that is of sufficient duration to meet
23	23	diagnostic criteria specified in the American Psychiatric
24	24	Association's Diagnostic and Statistical Manual of Mental
25	25	Disorders designated DSM-IV-TR; and
26	26	(C) with respect to which the person exhibits
27	27	impairment in thought, perception, affect, or behavior that
28	28	substantially interferes with or limits the person's role or
29	29	functioning in the person's community, school, family, or peer
30	30	group.
31	31	Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This chapter
32	32	applies only to a health benefit plan that provides benefits for
33	33	medical or surgical expenses incurred as a result of a health
34	34	condition, accident, or sickness, including an individual, group,
35	35	blanket, or franchise insurance policy or insurance agreement, a
36	36	group hospital service contract, or an individual or group evidence
37	37	of coverage or similar coverage document that is offered by:
38	38	(1) an insurance company;
39	39	(2) a group hospital service corporation operating
40	40	under Chapter 842;
41	41	(3) a fraternal benefit society operating under
42	42	Chapter 885;
43	43	(4) a stipulated premium insurance company operating
44	44	under Chapter 884;
45	45	(5) a reciprocal exchange operating under Chapter 942;
46	46	(6) a health maintenance organization operating under
47	47	Chapter 843;
48	48	(7) a multiple employer welfare arrangement that holds
49	49	a certificate of authority under Chapter 846; or
50	50	(8) an approved nonprofit health corporation that
51	51	holds a certificate of authority under Chapter 844.
52	52	(b) This chapter applies to group health coverage made
53	53	available by a school district in accordance with Section 22.004,
54	54	Education Code.
55	55	(c) Notwithstanding Section 172.014, Local Government Code,
56	56	or any other law, this chapter applies to health and accident
57	57	coverage provided by a risk pool created under Chapter 172, Local
58	58	Government Code.
59	59	(d) Notwithstanding any provision in Chapter 1551, 1575,
60	60	1579, or 1601 or any other law, this chapter applies to:
61	61	(1) a basic coverage plan under Chapter 1551;
62	62	(2) a basic plan under Chapter 1575;
63	63	(3) a primary care coverage plan under Chapter 1579;
64	64	and
65	65	(4) basic coverage under Chapter 1601.
66	66	(e) Notwithstanding any other law, a standard health
67	67	benefit plan provided under Chapter 1507 must provide the coverage
68	68	required by this chapter.
69	69	Sec. 1373.003. EXCEPTION. This chapter does not apply to:
70	70	(1) a plan that provides coverage:
71	71	(A) for wages or payments in lieu of wages for a
72	72	period during which an employee is absent from work because of
73	73	sickness or injury;
74	74	(B) as a supplement to a liability insurance
75	75	policy;
76	76	(C) for credit insurance;
77	77	(D) only for dental or vision care;
78	78	(E) only for hospital expenses; or
79	79	(F) only for indemnity for hospital confinement;
80	80	(2) a small employer health benefit plan written under
81	81	Chapter 1501, except when an independent school district elects to
82	82	participate in a small employer market in accordance with Section
83	83	1501.009;
84	84	(3) a Medicare supplemental policy as defined by
85	85	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
86	86	(4) a workers' compensation insurance policy;
87	87	(5) medical payment insurance coverage provided under
88	88	a motor vehicle insurance policy; or
89	89	(6) a long-term care policy, including a nursing home
90	90	fixed indemnity policy, unless the commissioner determines that the
91	91	policy provides benefit coverage so comprehensive that the policy
92	92	is a health benefit plan as described by Section 1373.002.
93	93	Sec. 1373.004. COVERAGE REQUIRED. Regardless of whether a
94	94	health benefit plan provides mental health coverage, a health
95	95	benefit plan must provide coverage for an enrollee, from birth
96	96	through the date the enrollee is 18 years of age, for a physical
97	97	injury to the enrollee that is self-inflicted:
98	98	(1) in an attempt to commit suicide, regardless of:
99	99	(A) the state of mental health of the enrollee;
100	100	or
101	101	(B) whether the injury results in the death of
102	102	the enrollee; or
103	103	(2) by an enrollee with a serious mental illness.
104	104	Sec. 1373.005. DEDUCTIBLE, COINSURANCE, AND COPAYMENT
105	105	REQUIREMENTS. The benefits required under this chapter may not be
106	106	made subject to a deductible, coinsurance, or copayment requirement
107	107	that exceeds the deductible, coinsurance, or copayment
108	108	requirements applicable to other physical injury benefits provided
109	109	under the health benefit plan.
110	110	Sec. 1373.006. RULES. The commissioner shall adopt rules as
111	111	necessary to administer this chapter.
112	112	SECTION 2. This Act applies only to a health benefit plan
113	113	that is delivered, issued for delivery, or renewed on or after
114	114	January 1, 2010. A health benefit plan that is delivered, issued
115	115	for delivery, or renewed before January 1, 2010, is governed by the
116	116	law as it existed immediately before the effective date of this Act,
117	117	and that law is continued in effect for that purpose.
118	118	SECTION 3. This Act takes effect September 1, 2009.