Texas 2015 - 84th Regular

Texas House Bill HB2979 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	84R26663 MEW-D
2	2	By: Anderson of Dallas, Isaac, Howard, H.B. No. 2979
3	3	Farney
4	4	Substitute the following for H.B. No. 2979:
5	5	By: Vo C.S.H.B. No. 2979
6	6
7	7
8	8	A BILL TO BE ENTITLED
9	9	AN ACT
10	10	relating to health benefit plan coverage of hearing aids for
11	11	certain individuals.
12	12	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
13	13	SECTION 1. Chapter 1367, Insurance Code, is amended by
14	14	adding Subchapter F to read as follows:
15	15	SUBCHAPTER F. HEARING AIDS
16	16	Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This
17	17	subchapter applies only to a health benefit plan, including a small
18	18	employer health benefit plan written under Chapter 1501 or coverage
19	19	provided by a health group cooperative under Subchapter B of that
20	20	chapter, that provides benefits for medical or surgical expenses
21	21	incurred as a result of a health condition, accident, or sickness,
22	22	including an individual, group, blanket, or franchise insurance
23	23	policy or insurance agreement, a group hospital service contract,
24	24	or an individual or group evidence of coverage or similar coverage
25	25	document that is offered by:
26	26	(1) an insurance company;
27	27	(2) a group hospital service corporation operating
28	28	under Chapter 842;
29	29	(3) a fraternal benefit society operating under
30	30	Chapter 885;
31	31	(4) a Lloyd's plan operating under Chapter 941;
32	32	(5) a stipulated premium insurance company operating
33	33	under Chapter 884;
34	34	(6) a reciprocal exchange operating under Chapter 942;
35	35	(7) a health maintenance organization operating under
36	36	Chapter 843;
37	37	(8) a multiple employer welfare arrangement that holds
38	38	a certificate of authority under Chapter 846; or
39	39	(9) an approved nonprofit health corporation that
40	40	holds a certificate of authority under Chapter 844.
41	41	(b) This subchapter applies to coverage under a group health
42	42	benefit plan described by Subsection (a) provided to a resident of
43	43	this state, regardless of whether the group policy or contract is
44	44	delivered, issued for delivery, or renewed within or outside this
45	45	state.
46	46	(c) This subchapter applies to group health coverage made
47	47	available by a school district in accordance with Section 22.004,
48	48	Education Code.
49	49	(d) This subchapter applies to a self-funded health benefit
50	50	plan sponsored by a professional employer organization under
51	51	Chapter 91, Labor Code.
52	52	(e) Notwithstanding Section 22.409, Business Organizations
53	53	Code, or any other law, this subchapter applies to a church benefits
54	54	board established under Chapter 22, Business Organizations Code.
55	55	(f) Notwithstanding Section 157.008, Local Government Code,
56	56	or any other law, this subchapter applies to a county employee
57	57	health benefit plan established under Chapter 157, Local Government
58	58	Code.
59	59	(g) Notwithstanding Section 75.104, Health and Safety Code,
60	60	or any other law, this subchapter applies to a regional or local
61	61	health care program established under Chapter 75, Health and Safety
62	62	Code.
63	63	(h) Notwithstanding any provision in Chapter 1551, 1575,
64	64	1579, or 1601 or any other law, this subchapter applies to:
65	65	(1) a basic coverage plan under Chapter 1551;
66	66	(2) a basic plan under Chapter 1575;
67	67	(3) a primary care coverage plan under Chapter 1579;
68	68	and
69	69	(4) basic coverage under Chapter 1601.
70	70	(i) Notwithstanding any other law, a standard health
71	71	benefit plan provided under Chapter 1507 must provide the coverage
72	72	required by this subchapter.
73	73	Sec. 1367.252. EXCEPTION. This subchapter does not apply
74	74	to:
75	75	(1) a plan that provides coverage:
76	76	(A) for wages or payments in lieu of wages for a
77	77	period during which an employee is absent from work because of
78	78	sickness or injury;
79	79	(B) as a supplement to a liability insurance
80	80	policy;
81	81	(C) for credit insurance;
82	82	(D) only for dental or vision care;
83	83	(E) only for hospital expenses; or
84	84	(F) only for indemnity for hospital confinement;
85	85	(2) a Medicare supplemental policy as defined by
86	86	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
87	87	(3) a workers' compensation insurance policy;
88	88	(4) medical payment insurance coverage provided under
89	89	a motor vehicle insurance policy;
90	90	(5) a long-term care policy, including a nursing home
91	91	fixed indemnity policy, unless the commissioner determines that the
92	92	policy provides benefit coverage so comprehensive that the policy
93	93	is a health benefit plan as described by Section 1367.251;
94	94	(6) a Medicaid managed care program operated under
95	95	Chapter 533, Government Code; or
96	96	(7) a Medicaid program operated under Chapter 32,
97	97	Human Resources Code.
98	98	Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit
99	99	plan must provide coverage for the cost of a medically necessary
100	100	hearing aid and related services and supplies for a covered
101	101	individual who is 18 years of age or younger.
102	102	(b) Coverage required under this section is limited to one
103	103	hearing aid in each ear every three years.
104	104	(c) Except as provided by Subsection (b), coverage required
105	105	under this section:
106	106	(1) may not be less favorable than coverage for
107	107	physical illness generally under the plan; and
108	108	(2) must be subject to durational limits and
109	109	coinsurance factors no less favorable than coverage provided for
110	110	physical illness generally under the plan.
111	111	(d) This section does not apply to a qualified health plan
112	112	defined by 45 C.F.R. Section 155.20 if a determination is made under
113	113	45 C.F.R. Section 155.170 that:
114	114	(1) this subchapter requires the qualified health plan
115	115	to offer benefits in addition to the essential health benefits
116	116	required under 42 U.S.C. Section 18022(b); and
117	117	(2) this state must make payments to defray the cost of
118	118	the additional benefits mandated by this subchapter.
119	119	SECTION 2. The change in law made by this Act applies only
120	120	to a health benefit plan delivered, issued for delivery, or renewed
121	121	on or after January 1, 2016. A health benefit plan delivered, issued
122	122	for delivery, or renewed before January 1, 2016, is governed by the
123	123	law in effect immediately before the effective date of this Act, and
124	124	that law is continued in effect for that purpose.
125	125	SECTION 3. This Act takes effect September 1, 2015.