84R1526 PMO-D
By: Coleman, Morrison H.B. No. 2219
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for injuries related to
certain conduct of a covered individual.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1380 to read as follows:
CHAPTER 1380. COVERAGE RELATING TO INJURIES RELATED TO CERTAIN
CONDUCT
Sec. 1380.001. 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 health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885; or
(8) an exchange operating under Chapter 942.
(b) Notwithstanding Section 1501.251 or any other law, this
chapter applies to coverage under a small employer health benefit
plan subject to Chapter 1501.
(c) This chapter applies to a consumer choice of benefits
plan issued under Chapter 1507.
Sec. 1380.002. CONDITIONAL EXCEPTION. This chapter does
not apply to a qualified health plan if a determination is made
under 45 C.F.R. Section 155.170 that:
(1) this chapter requires the plan to offer benefits
in addition to the essential health benefits required under 42
U.S.C. Section 18022(b); and
(2) this state is required to defray the cost of the
benefits mandated under this chapter.
Sec. 1380.003. EXCLUSION OF COVERAGE PROHIBITED. (a) A
health benefit plan may not exclude coverage for any emergency or
other medical, hospital, or surgical expenses incurred by a covered
individual as a result of and related to an injury that is
self-inflicted or caused in an attempt to commit suicide,
regardless of:
(1) the individual's state of mental health; or
(2) whether the injury results in the individual's
death.
(b) Coverage required under this chapter may be subject to
deductibles, copayments, coinsurance, or annual or maximum payment
limits that are consistent with deductibles, copayments,
coinsurance, or annual or maximum payment limits applicable to
other similar coverage under the health benefit plan.
Sec. 1380.004. RULES. The commissioner shall adopt rules
necessary to implement this chapter.
SECTION 2. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2016. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2016,
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, 2015.