Relating to health benefit plan coverage for acquired brain injuries.
The bill enforces more stringent requirements on health benefit plan issuers, mandating written notification to insureds regarding the specific coverages related to acquired brain injuries. Additionally, the bill sets out clear expectations for response times on appeals related to medical necessity, requiring health plans to act within three business days. This ensures that claimants receive timely information and have their appeals addressed promptly, potentially reducing delays in critical medical care.
SB1348 is a legislative bill aimed at enhancing health benefit plan coverage for individuals suffering from acquired brain injuries. The bill amends several sections of the Texas Insurance Code to ensure that health benefit plans, including those for small employers, provide necessary medical services related to acquired brain injuries. This is significant since such injuries often require specialized treatment and long-term care, which some existing plans may inadequately cover or entirely exclude.
While the bill is largely seen as a step forward for those affected by acquired brain injuries, it may face resistance from insurance groups concerned about the financial implications of mandating broader coverage. Critics argue that adding such requirements could lead to increased premiums for all policyholders or result in restrictive practices by insurance providers trying to mitigate new costs. Proponents, however, emphasize the essential nature of these changes for improving health outcomes for a vulnerable population.