Texas 2009 - 81st Regular

Texas Senate Bill SB2076 Compare Versions

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

Old	New	Differences
1	1	2009S0680-1 03/11/09
2	2	By: Uresti S.B. No. 2076
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health insurance coverage for diagnosis and treatment
8	8	of conditions affecting the temporomandibular joint.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Sections 1360.002, 1360.003, 1360.004, and
11	11	1360.005, Insurance Code, are amended to read as follows:
12	12	Sec. 1360.002. APPLICABILITY OF CHAPTER. (a) Except as
13	13	provided by Subsection (b), this [This] chapter applies [only] to a
14	14	group health benefit plan delivered or issued for delivery in this
15	15	state that:
16	16	(1) provides benefits for dental, medical, or surgical
17	17	expenses incurred as a result of a health condition, accident, or
18	18	sickness, including:
19	19	(A) a group, blanket, or franchise insurance
20	20	policy or insurance agreement, a group hospital service contract,
21	21	or a group evidence of coverage that is offered by:
22	22	(i) an insurance company;
23	23	(ii) a group hospital service corporation
24	24	operating under Chapter 842;
25	25	(iii) a fraternal benefit society operating
26	26	under Chapter 885;
27	27	(iv) a stipulated premium company operating
28	28	under Chapter 884; or
29	29	(v) a health maintenance organization
30	30	operating under Chapter 843; and
31	31	(B) to the extent permitted by the Employee
32	32	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
33	33	seq.), a health benefit plan that is offered by:
34	34	(i) a multiple employer welfare arrangement
35	35	as defined by Section 3 of that Act;
36	36	(ii) an entity not authorized under this
37	37	code or another insurance law of this state that contracts directly
38	38	for health care services on a risk-sharing basis, including a
39	39	capitation basis; or
40	40	(iii) another analogous benefit
41	41	arrangement; or
42	42	(2) is offered by an approved nonprofit health
43	43	corporation that holds a certificate of authority under Chapter
44	44	844.
45	45	(b) This chapter applies to an individual insurance policy
46	46	delivered or issued for delivery in this state that provides
47	47	benefits for dental, medical, or surgical expenses incurred as a
48	48	result of a health condition, accident, or sickness.
49	49	Sec. 1360.003. EXCEPTION. This chapter does not apply to:
50	50	(1) a plan or policy that provides coverage:
51	51	(A) only for a specified disease or another
52	52	limited benefit;
53	53	(B) only for accidental death or dismemberment;
54	54	(C) for wages or payments in lieu of wages for a
55	55	period during which an employee is absent from work because of
56	56	sickness or injury;
57	57	(D) as a supplement to a liability insurance
58	58	policy;
59	59	(E) for credit insurance;
60	60	(F) only for vision care; or
61	61	(G) only for indemnity for hospital confinement;
62	62	(2) a Medicare supplemental policy as defined by
63	63	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
64	64	(3) a workers' compensation insurance policy;
65	65	(4) a small employer health benefit plan written under
66	66	Chapter 1501;
67	67	(5) medical payment insurance coverage provided under
68	68	a motor vehicle insurance policy; or
69	69	(6) a long-term care insurance policy, including a
70	70	nursing home fixed indemnity policy, unless the commissioner
71	71	determines that the policy provides benefit coverage so
72	72	comprehensive that the policy is a health benefit plan as described
73	73	by Section 1360.002.
74	74	Sec. 1360.004. COVERAGE REQUIRED. (a) A health benefit
75	75	plan or individual insurance policy that provides coverage for
76	76	medically necessary diagnostic or surgical treatment of conditions
77	77	affecting skeletal joints must provide comparable coverage for
78	78	diagnostic or surgical treatment of conditions affecting the
79	79	temporomandibular joint if the treatment is medically necessary as
80	80	a result of:
81	81	(1) an accident;
82	82	(2) a trauma;
83	83	(3) a congenital defect;
84	84	(4) a developmental defect; or
85	85	(5) a pathology.
86	86	(b) Coverage required under this section may be subject to
87	87	any provision in the health benefit plan or individual insurance
88	88	policy that is generally applicable to surgical treatment,
89	89	including a requirement for precertification of coverage.
90	90	Sec. 1360.005. DENTAL SERVICES COVERAGE NOT REQUIRED.
91	91	(a) This chapter does not require a health benefit plan or
92	92	individual insurance policy to provide coverage for dental services
93	93	if dental services are not otherwise scheduled or provided as part
94	94	of the coverage provided under the plan.
95	95	(b) A health benefit plan or individual insurance policy may
96	96	not exclude from coverage under the plan or policy an individual who
97	97	is unable to undergo dental treatment in an office setting or under
98	98	local anesthesia due to a documented physical, mental, or medical
99	99	reason as determined by the individual's physician or by the
100	100	dentist providing the dental care.
101	101	SECTION 2. This Act applies only to an insurance policy that
102	102	is delivered, issued for delivery, or renewed on or after January 1,
103	103	2010. A policy delivered, issued for delivery, or renewed before
104	104	January 1, 2010, is governed by the law as it existed immediately
105	105	before the effective date of this Act, and that law is continued in
106	106	effect for that purpose.
107	107	SECTION 3. This Act takes effect September 1, 2009.