Texas 2015 - 84th Regular

Texas House Bill HB2541 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		84R20872 PMO-F
2		-	By: Zerwas H.B. No. 2541
3		-	Substitute the following for H.B. No. 2541:
4		-	By: Paul C.S.H.B. No. 2541
	2	+	By: Zerwas, Guillen H.B. No. 2541
5	3
6	4
7	5		A BILL TO BE ENTITLED
8	6		AN ACT
9	7		relating to health benefit plan coverage of certain treatments for
10	8		enrollees diagnosed with a terminal illness; authorizing
11	9		administrative and civil penalties.
12	10		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	11		SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
14	12		by adding Chapter 1372 to read as follows:
15	13		CHAPTER 1372. ACCESS TO TREATMENT FOR INDIVIDUALS WITH A TERMINAL
16	14		ILLNESS
17	15		Sec. 1372.001. DEFINITIONS. In this chapter:
18	16		(1) "Enrollee" means an individual entitled to
19	17		coverage under a health benefit plan.
20	18		(2) "Physician" means an individual licensed to
21	19		practice medicine in this state.
22	20		(3) "Terminal illness" means an illness or physical
23	21		condition, including a physical injury, that can reasonably be
24	22		expected to result in death within not more than two years.
25	23		Sec. 1372.002. APPLICABILITY OF CHAPTER. (a) This chapter
26	24		applies only to a health benefit plan that provides benefits for
27	25		medical or surgical expenses incurred as a result of a health
28	26		condition, accident, or sickness, including an individual, group,
29	27		blanket, or franchise insurance policy or insurance agreement, a
30	28		group hospital service contract, or an individual or group evidence
31	29		of coverage or similar coverage document that is offered by:
32	30		(1) an insurance company;
33	31		(2) a group hospital service corporation operating
34	32		under Chapter 842;
35	33		(3) a health maintenance organization operating under
36	34		Chapter 843;
37	35		(4) an approved nonprofit health corporation that
38	36		holds a certificate of authority under Chapter 844;
39	37		(5) a multiple employer welfare arrangement that holds
40	38		a certificate of authority under Chapter 846;
41	39		(6) a stipulated premium company operating under
42	40		Chapter 884;
43	41		(7) a fraternal benefit society operating under
44	42		Chapter 885; or
45	43		(8) an exchange operating under Chapter 942.
46	44		(b) This chapter applies to group health coverage made
47	45		available by a school district in accordance with Section 22.004,
48	46		Education Code.
49	47		(c) Notwithstanding any provision in Chapter 1551, 1575,
50	48		1579, or 1601 or any other law, this chapter applies to health
51	49		benefit plan coverage provided under:
52	50		(1) Chapter 1551;
53	51		(2) Chapter 1575;
54	52		(3) Chapter 1579; and
55	53		(4) Chapter 1601.
56	54		(d) Notwithstanding Section 1501.251 or any other law, this
57	55		chapter applies to coverage under a small employer health benefit
58	56		plan subject to Chapter 1501.
59	57		(e) This chapter applies to a consumer choice of benefits
60	58		plan issued under Chapter 1507.
61	59		(f) To the extent allowed by federal law, the child health
62	60		plan program operated under Chapter 62, Health and Safety Code, the
63	61		health benefits plan for children operated under Chapter 63, Health
64	62		and Safety Code, the state Medicaid program, and a managed care
65	63		organization that contracts with the Health and Human Services
66	64		Commission to provide health care services to recipients through a
67	65		managed care plan shall provide coverage to a recipient in
68	66		accordance with this chapter.
69	67		Sec. 1372.003. EXCEPTION TO APPLICABILITY OF CHAPTER. This
70	68		chapter does not apply to:
71	69		(1) a health benefit plan that provides coverage:
72	70		(A) only for a specified disease or for another
73	71		limited benefit;
74	72		(B) only for accidental death or dismemberment;
75	73		(C) for wages or payments in lieu of wages for a
76	74		period during which an employee is absent from work because of
77	75		sickness or injury;
78	76		(D) as a supplement to a liability insurance
79	77		policy;
80	78		(E) for credit insurance;
81	79		(F) only for dental or vision care;
82	80		(G) only for hospital expenses; or
83	81		(H) only for indemnity for hospital confinement;
84	82		(2) a Medicare supplemental policy as defined by
85	83		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
86	84		(3) a workers' compensation insurance policy;
87	85		(4) medical payment insurance coverage provided under
88	86		a motor vehicle insurance policy; or
89	87		(5) a long-term care insurance policy, including a
90	88		nursing home fixed indemnity policy, unless the commissioner
91	89		determines that the policy provides benefit coverage so
92	90		comprehensive that the policy is a health benefit plan as described
93	91		by Section 1372.002.
94	92		Sec. 1372.004. APPLICABILITY TO CERTAIN TREATMENT. This
95	93		chapter applies to treatment for an enrollee diagnosed by a
96	94		physician with a terminal illness:
97	95		(1) that is:
98	96		(A) medically accepted as treatment for the
99	97		terminal illness or another illness or condition with which the
100	98		enrollee has been diagnosed by a physician; and
101	99		(B) prescribed by a physician to treat the
102	100		terminal illness or other illness or condition; and
103	101		(2) to which the enrollee or the enrollee's legal
104	102		guardian or other legal representative consents.
105	103		Sec. 1372.005. CERTAIN DENIALS OF COVERAGE PROHIBITED.
106	104		Notwithstanding any other law, a health benefit plan may not deny
107	105		coverage for a treatment to which this chapter applies based solely
108	106		on the enrollee's diagnosis with a terminal illness.
109	107		Sec. 1372.006. PROHIBITED CONDUCT. A health benefit plan
110	108		issuer or third-party administrator may not with respect to a
111	109		treatment to which this chapter applies:
112	110		(1) refuse to accept a physician's recommendation of
113	111		the treatment based solely on the enrollee's diagnosis with a
114	112		terminal illness; or
115	113		(2) reduce, prohibit, or deny payment or other forms
116	114		of reimbursement for the treatment based solely on the enrollee's
117	115		diagnosis with a terminal illness.
118	116		Sec. 1372.007. UNFAIR OR DECEPTIVE ACT OR PRACTICE; UNFAIR
119	117		CLAIM SETTLEMENT PRACTICE. A violation of this chapter is an unfair
120	118		or deceptive act or practice in the business of insurance for
121	119		purposes of Chapter 541 and an unfair claim settlement practice for
122	120		purposes of Chapter 542.
123	121		Sec. 1372.008. ADMINISTRATIVE PENALTIES. A health benefit
124	122		plan issuer or third-party administrator that commits a violation
125	123		of this chapter is subject to administrative penalties under
126	124		Chapters 82 and 84.
127	125		SECTION 2. Chapter 1372, Insurance Code, as added by this
128	126		Act, applies only to a health benefit plan that is delivered, issued
129	127		for delivery, or renewed on or after September 1, 2015. A plan
130	128		delivered, issued for delivery, or renewed before September 1,
131	129		2015, is governed by the law as it existed immediately before the
132	130		effective date of this Act, and that law is continued in effect for
133	131		that purpose.
134	132		SECTION 3. This Act takes effect September 1, 2015.