81R10708 AJA-F
By: Averitt S.B. No. 1545
A BILL TO BE ENTITLED
AN ACT
relating to health benefit coverage for children and grandchildren.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 846.260, Insurance Code, is amended to
read as follows:
Sec. 846.260. LIMITING AGE APPLICABLE TO [UNMARRIED] CHILD.
Children [If children] are eligible for coverage under the terms of
a multiple employer welfare arrangement's plan document, and there
is no [any] limiting age applicable to a [an unmarried] child of an
enrollee [is 25 years of age].
SECTION 2. Section 1201.053(b), Insurance Code, is amended
to read as follows:
(b) On the application of an adult member of a family, an
individual accident and health insurance policy may, at the time of
original issuance or by subsequent amendment, insure two or more
eligible members of the adult's family, including:
(1) a spouse;
(2) [, unmarried] children [younger than 25 years of
age], including a grandchild of the adult as described by Section
1201.062(a)(1);
(3) [,] a child the adult is required to insure under a
medical support order issued under Chapter 154, Family Code, or
enforceable by a court in this state;[,] and
(4) any [other] individual dependent on the adult.
SECTION 3. Section 1201.062(a), Insurance Code, is amended
to read as follows:
(a) An individual or group accident and health insurance
policy that is delivered, issued for delivery, or renewed in this
state, including a policy issued by a corporation operating under
Chapter 842, or a self-funded or self-insured welfare or benefit
plan or program, to the extent that regulation of the plan or
program is not preempted by federal law, must provide [that
provides] coverage for a child of an insured or group member, on
payment of a premium, and must provide coverage for:
(1) each grandchild of the insured or group member [if
the grandchild is:
[(A) unmarried;
[(B) younger than 25 years of age; and
[(C) a dependent of the insured or group member
for federal income tax purposes at the time application for
coverage of the grandchild is made]; and
(2) each child for whom the insured or group member
must provide medical support under an order issued under Chapter
154, Family Code, or enforceable by a court in this state.
SECTION 4. Section 1251.151(a), Insurance Code, is amended
to read as follows:
(a) A group policy or contract of insurance for hospital,
surgical, or medical expenses incurred as a result of accident or
sickness, including a group contract issued by a group hospital
service corporation, that provides coverage under the policy or
contract for a child of an insured must, on payment of a premium,
provide coverage for any grandchild of the insured [if the
grandchild is:
[(1) unmarried;
[(2) younger than 25 years of age; and
[(3) a dependent of the insured for federal income tax
purposes at the time the application for coverage of the grandchild
is made].
SECTION 5. Section 1251.152, Insurance Code, is amended to
read as follows:
Sec. 1251.152. OPTIONAL COVERAGE FOR SPOUSES AND
DEPENDENTS. (a) For purposes of this section, "dependent"
includes:
(1) a child of an employee or member [who is:
[(A) unmarried; and
[(B) younger than 25 years of age]; and
(2) a grandchild of an employee or member [who is:
[(A) unmarried;
[(B) younger than 25 years of age; and
[(C) a dependent of the insured for federal
income tax purposes at the time the application for coverage of the
grandchild is made].
(b) A group accident and health insurance policy must [may]
provide coverage for the spouse or a dependent of an employee or
member.
SECTION 6. Section 1271.006, Insurance Code, is amended to
read as follows:
Sec. 1271.006. BENEFITS TO DEPENDENT CHILD AND GRANDCHILD.
Children [(a) If children] are eligible for coverage under the
terms of an evidence of coverage, and there is no [any] limiting age
applicable to a [an unmarried] child of an enrollee, including a [an
unmarried] grandchild of an enrollee[, is 25 years of age. The
limiting age applicable to a child must be stated in the evidence of
coverage.
[(b) A health maintenance organization may provide benefits
under a health care plan to an enrollee's dependent grandchild who
is living with and in the household of the enrollee].
SECTION 7. Section 1501.002(2), Insurance Code, is amended
to read as follows:
(2) "Dependent" means:
(A) a spouse;
(B) a child [younger than 25 years of age],
including a newborn child;
(C) [a child of any age who is:
[(i) medically certified as disabled; and
[(ii) dependent on the parent;
[(D)] an individual who must be covered under:
(i) Section 1251.154; or
(ii) Section 1201.062; and
(D) [(E)] any other child eligible under an
employer's health benefit plan[, including a child described by
Section 1503.003].
SECTION 8. Section 1501.609, Insurance Code, is amended to
read as follows:
Sec. 1501.609. COVERAGE FOR [UNMARRIED] CHILDREN. Children
[(a) This section applies only if children] are eligible for
coverage under a large employer health benefit plan.
[(b) Any limiting age applicable under a large employer
health benefit plan to an unmarried child of an enrollee is 25 years
of age.]
SECTION 9. Section 1507.003(b), Insurance Code, is amended
to read as follows:
(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 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; and
(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, and
1201.064 [1201.063-1201.065,] and Subchapter A, Chapter 1367;
(C) Chapter 1504;
(D) [Chapter 1503;
[(E)] Section 1501.157;
(E) [(F)] Section 1501.158; and
(F) [(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
available through network physicians or providers, as required by
Section 1271.055; and
(12) coverage for cancer screenings under:
(A) Chapter 1356;
(B) Chapter 1362;
(C) Chapter 1363; and
(D) Chapter 1370.
SECTION 10. Section 1507.053(b), Insurance Code, is amended
to read as follows:
(b) For purposes of this subchapter, "state-mandated health
benefits" does not include coverage that is mandated by federal law
or standard provisions or rights required under this code or other
laws of this state to be provided in an evidence of coverage that
are unrelated to a specific health illness, injury, or condition of
an enrollee, including provisions related to:
(1) continuation of coverage under Subchapter G,
Chapter 1251;
(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) Chapter 1504;
(B) [Chapter 1503;
[(C)] Section 1501.157;
(C) [(D)] Section 1501.158; and
(D) [(E)] Sections 1501.607-1501.609;
(5) services of providers under Section 843.304;
(6) coverage for serious mental health illness under
Subchapter A, Chapter 1355; and
(7) coverage for cancer screenings under:
(A) Chapter 1356;
(B) Chapter 1362;
(C) Chapter 1363; and
(D) Chapter 1370.
SECTION 11. Subchapter D, Chapter 1551, Insurance Code, is
amended by adding Section 1551.160 to read as follows:
Sec. 1551.160. COVERAGE FOR CERTAIN CHILDREN AND
GRANDCHILDREN. (a) Notwithstanding any other provision of this
chapter, an employee, annuitant, spouse, or surviving spouse
participating in the group benefits program is entitled to obtain
health benefit coverage under the program for any child or
grandchild of the employee, annuitant, spouse, or surviving spouse
without regard to the age of the child.
(b) For a child or grandchild who is covered under this
section and who would not otherwise be eligible for coverage under
this chapter:
(1) a state contribution is not payable; and
(2) the employee, annuitant, spouse, or surviving
spouse must pay, in the manner required by the board of trustees,
the total cost, as determined by the board, attributable to the
participation of the child or grandchild.
SECTION 12. Section 1575.003(1), Insurance Code, is amended
to read as follows:
(1) "Dependent" means:
(A) the spouse of a retiree; or
(B) a [an unmarried] child of a retiree or
deceased active member [if the child is younger than 25 years of
age], including:
(i) an adopted child;
(ii) a foster child, stepchild, or other
child who is in a regular parent-child relationship; or
(iii) a recognized natural child[;
[(C) a retiree's recognized natural child,
adopted child, foster child, stepchild, or other child who is in a
regular parent-child relationship and who lives with or has his or
her care provided by the retiree or surviving spouse on a regular
basis regardless of the child's age, if the child is mentally
retarded or physically incapacitated to an extent that the child is
dependent on the retiree or surviving spouse for care or support, as
determined by the trustee; or
[(D) a deceased active member's recognized
natural child, adopted child, foster child, stepchild, or other
child who is in a regular parent-child relationship, without regard
to the age of the child, if, while the active member was alive, the
child:
[(i) lived with or had the child's care
provided by the active member on a regular basis; and
[(ii) was mentally retarded or physically
incapacitated to an extent that the child was dependent on the
active member or surviving spouse for care or support, as
determined by the trustee].
SECTION 13. Subchapter D, Chapter 1575, Insurance Code, is
amended by adding Section 1575.1575 to read as follows:
Sec. 1575.1575. COVERAGE FOR CERTAIN CHILDREN AND
GRANDCHILDREN. (a) Notwithstanding any other provision of this
chapter, a retiree, spouse, or surviving spouse participating in
the group program is entitled to obtain health coverage plan
coverage under the program for any child or grandchild of the
retiree, spouse, or surviving spouse without regard to the age of
the child.
(b) For a child or grandchild who is covered under this
section and who would not otherwise be eligible for coverage under
this chapter:
(1) a state contribution is not payable; and
(2) the retiree, spouse, or surviving spouse must pay,
in the manner required by the trustee, the total cost, as determined
by the trustee, attributable to the participation of the child or
grandchild.
SECTION 14. The heading of Subchapter E, Chapter 1579,
Insurance Code, is amended to read as follows:
SUBCHAPTER E. PARTICIPATION BY EMPLOYEE OR DEPENDENT
SECTION 15. Subchapter E, Chapter 1579, Insurance Code, is
amended by adding Section 1579.206 to read as follows:
Sec. 1579.206. COVERAGE FOR CERTAIN CHILDREN AND
GRANDCHILDREN. (a) Notwithstanding any other provision of this
chapter, an employee or spouse participating in the program is
entitled to obtain health coverage plan coverage under the program
for any child or grandchild of the employee or spouse without regard
to the age of the child.
(b) For a child or grandchild who is covered under this
section and who would not otherwise be eligible for coverage under
this chapter:
(1) a state contribution is not payable; and
(2) the employee or spouse must pay, in the manner
required by the trustee, the total cost, as determined by the
trustee, attributable to the participation of the child or
grandchild.
SECTION 16. Section 1601.004(a), Insurance Code, is amended
to read as follows:
(a) In this chapter, "dependent," with respect to an
individual eligible to participate in the uniform program under
Section 1601.101 or 1601.102, means the individual's:
(1) spouse; and
(2) [unmarried] child [younger than 25 years of age;
and
[(3) child of any age who lives with or has the child's
care provided by the individual on a regular basis if the child is
mentally retarded or physically incapacitated to the extent that
the child is dependent on the individual for care or support, as
determined by the system].
SECTION 17. Subchapter C, Chapter 1601, Insurance Code, is
amended by adding Section 1601.112 to read as follows:
Sec. 1601.112. COVERAGE FOR CERTAIN CHILDREN AND
GRANDCHILDREN. (a) Notwithstanding any other provision of this
chapter, an employee, retiree, spouse, or surviving spouse
participating in a uniform program is entitled to obtain health
benefit coverage under the program for any child or grandchild of
the employee, retiree, spouse, or surviving spouse without regard
to the age of the child.
(b) For a child or grandchild who is covered under this
section and who would not otherwise be eligible for coverage under
this chapter:
(1) a state contribution is not payable; and
(2) the employee, retiree, spouse, or surviving spouse
must pay, in the manner required by the applicable system, the total
cost, as determined by the system, attributable to the
participation of the child or grandchild.
SECTION 18. Section 4001.009(a), Insurance Code, is amended
to read as follows:
(a) As referenced in Section 4001.003(9), a reference to an
agent in the following laws includes a subagent without regard to
whether a subagent is specifically mentioned:
(1) Chapters 281, 402, 421-423, 441, 444, 461-463,
523, 541-556, 558, 559, [702,] 703, 705, 821, 823-825, 827, 828,
844, 963, 1108, 1205-1208[1205-1209], 1211-1214, 1352, 1353, 1357,
1358, 1360-1363, 1369, 1453-1455, [1503,] 1550, 1801, 1803,
2151-2154, 2201-2203, 2205-2213, 3501, 3502, 4007, 4102, and
4201-4203;
(2) Chapter 403, excluding Section 403.002;
(3) Subchapter A, Chapter 491;
(4) Subchapter C, Chapter 521;
(5) Subchapter A, Chapter 557;
(6) Subchapter B, Chapter 805;
(7) Subchapters D, E, and F, Chapter 982;
(8) Subchapter D, Chapter 1103;
(9) Subchapters B, C, D, and E, Chapter 1204,
excluding Sections 1204.153 and 1204.154;
(10) Subchapter B, Chapter 1366;
(11) Subchapters B, C, and D, Chapter 1367, excluding
Section 1367.053(c);
(12) Subchapters A, C, D, E, F, H, and I, Chapter 1451;
(13) Subchapter B, Chapter 1452;
(14) Sections 551.004, 841.303, 982.001, 982.002,
982.004, 982.052, 982.102, 982.103, 982.104, 982.106, 982.107,
982.108, 982.110, 982.111, 982.112, and 1802.001; and
(15) Chapter 107, Occupations Code.
SECTION 19. The following laws are repealed:
(1) Sections 1201.059 and 1201.065, Insurance Code;
and
(2) Chapter 1503, Insurance Code.
SECTION 20. The changes in law made by this Act apply only
to a health benefit plan, the contract, policy, or evidence of
coverage for which is delivered, issued for delivery, or renewed on
or after the effective date of this Act. A health benefit plan, the
contract, policy, or evidence of coverage for which is delivered,
issued for delivery, or renewed before the effective date of this
Act, is covered by the law in effect at the time the contract,
policy, or evidence of coverage is delivered, issued for delivery,
or renewed, and that law is continued in effect for that purpose.
SECTION 21. This Act takes effect September 1, 2009.