81R10199 PB-D
By: Coleman H.B. No. 2975
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for certain physical
injuries that are self-inflicted by a minor.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1373 to read as follows:
CHAPTER 1373. COVERAGE FOR CERTAIN SELF-INFLICTED
PHYSICAL INJURIES BY MINORS
Sec. 1373.001. DEFINITIONS. In this chapter:
(1) "Enrollee" means an individual entitled to
coverage under a health benefit plan.
(2) "Serious mental illness" has the meaning assigned
by Section 1355.001 and also includes a diagnosable behavioral or
emotional disorder or a neuropsychiatric condition:
(A) that results in a serious disability
requiring sustained treatment interventions;
(B) that is of sufficient duration to meet
diagnostic criteria specified in the American Psychiatric
Association's Diagnostic and Statistical Manual of Mental
Disorders designated DSM-IV-TR; and
(C) with respect to which the person exhibits
impairment in thought, perception, affect, or behavior that
substantially interferes with or limits the person's role or
functioning in the person's community, school, family, or peer
group.
Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This chapter
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 fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium insurance company operating
under Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a health maintenance organization operating under
Chapter 843;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) This chapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(c) Notwithstanding Section 172.014, Local Government Code,
or any other law, this chapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(d) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(e) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this chapter.
Sec. 1373.003. EXCEPTION. This chapter 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;
(B) as a supplement to a liability insurance
policy;
(C) for credit insurance;
(D) only for dental or vision care;
(E) only for hospital expenses; or
(F) only for indemnity for hospital confinement;
(2) a small employer health benefit plan written under
Chapter 1501, except when an independent school district elects to
participate in a small employer market in accordance with Section
1501.009;
(3) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(6) a long-term care policy, including a nursing home
fixed indemnity policy, unless the commissioner determines that the
policy provides benefit coverage so comprehensive that the policy
is a health benefit plan as described by Section 1373.002.
Sec. 1373.004. COVERAGE REQUIRED. Regardless of whether a
health benefit plan provides mental health coverage, a health
benefit plan must provide coverage for an enrollee, from birth
through the date the enrollee is 18 years of age, for a physical
injury to the enrollee that is self-inflicted:
(1) in an attempt to commit suicide, regardless of:
(A) the state of mental health of the enrollee;
or
(B) whether the injury results in the death of
the enrollee; or
(2) by an enrollee with a serious mental illness.
Sec. 1373.005. DEDUCTIBLE, COINSURANCE, AND COPAYMENT
REQUIREMENTS. The benefits required under this chapter may not be
made subject to a deductible, coinsurance, or copayment requirement
that exceeds the deductible, coinsurance, or copayment
requirements applicable to other physical injury benefits provided
under the health benefit plan.
Sec. 1373.006. RULES. The commissioner shall adopt rules as
necessary to administer this chapter.
SECTION 2. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2010. A health benefit plan that is delivered, issued
for delivery, or renewed before January 1, 2010, 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, 2009.