Texas 2015 - 84th Regular

Texas Senate Bill SB1349 Compare Versions

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

Old	New	Differences
1	1	84R4915 KKR-F
2	2	By: Hinojosa S.B. No. 1349
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to coordination of dental benefits under certain insurance
8	8	policies.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1203, Insurance Code, is amended by
11	11	adding Subchapter B to read as follows:
12	12	SUBCHAPTER B. DENTAL INSURANCE
13	13	Sec. 1203.051. APPLICABILITY OF SUBCHAPTER. This
14	14	subchapter applies only to an insurance policy that provides
15	15	benefits for dental expenses, including an individual, group,
16	16	blanket, or franchise insurance policy or insurance agreement, or a
17	17	group hospital service contract, that is offered by:
18	18	(1) an insurance company;
19	19	(2) a group hospital service corporation operating
20	20	under Chapter 842;
21	21	(3) a fraternal benefit society operating under
22	22	Chapter 885;
23	23	(4) a stipulated premium company operating under
24	24	Chapter 884;
25	25	(5) a reciprocal exchange operating under Chapter 942;
26	26	or
27	27	(6) a Lloyd's plan operating under Chapter 941.
28	28	Sec. 1203.052. COORDINATION OF BENEFITS BETWEEN PRIMARY AND
29	29	SECONDARY PROVIDER. (a) This section applies if:
30	30	(1) an insured is covered by at least two different
31	31	insurance policies; and
32	32	(2) each policy provides the insured dental benefits.
33	33	(b) The primary insurer, as determined under a coordination
34	34	of benefits provision applicable to the policies, is responsible
35	35	for dental expenses covered under the insurance policy issued by
36	36	the primary insurer up to the full amount of the applicable policy
37	37	limit.
38	38	(c) Before the policy limit described by Subsection (b) is
39	39	reached, the secondary insurer, as determined under a coordination
40	40	of benefits provision applicable to the policies, is responsible
41	41	only for dental expenses covered under the insurance policy issued
42	42	by the secondary insurer that are not covered under the policy
43	43	issued by the primary insurer.
44	44	(d) After the policy limit described by Subsection (b) has
45	45	been reached, the secondary insurer, in addition to the
46	46	responsibility described by Subsection (c), is responsible for any
47	47	dental expenses covered by both policies that exceed the policy
48	48	limit described by Subsection (b), up to the full amount of the
49	49	applicable policy limit of the insurance policy issued by the
50	50	secondary insurer.
51	51	Sec. 1203.053. CERTAIN COORDINATION OF BENEFITS PROVISIONS
52	52	PROHIBITED. An insurance policy subject to this subchapter may not
53	53	be delivered, issued for delivery, or renewed in this state if:
54	54	(1) a provision of the policy excludes or reduces the
55	55	payment of benefits for dental expenses to or on behalf of an
56	56	insured;
57	57	(2) the reason for the exclusion or reduction is that
58	58	dental benefits are payable or have been paid to or on behalf of the
59	59	insured under another insurance policy; and
60	60	(3) the exclusion or reduction would apply before the
61	61	full amount of the dental expenses incurred by the insured and
62	62	covered by both policies have been paid or reimbursed or the full
63	63	amount of the applicable policy limit of the policy containing the
64	64	exclusion or reduction is reached.
65	65	Sec. 1203.054. CERTAIN COORDINATION OF BENEFITS PROVISIONS
66	66	VOID. A provision of an insurance policy that violates Section
67	67	1203.053 is void.
68	68	SECTION 2. Chapter 1203, Insurance Code, is amended by
69	69	designating Sections 1203.001 through 1203.003 as Subchapter A and
70	70	adding a subchapter heading to read as follows:
71	71	SUBCHAPTER A. SUPPLEMENTAL INSURANCE POLICIES
72	72	SECTION 3. Section 1203.001, Insurance Code, is amended to
73	73	read as follows:
74	74	Sec. 1203.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. (a)
75	75	This subchapter [chapter] applies only to:
76	76	(1) a policy of group accident and health insurance as
77	77	described by Chapter 1251;
78	78	(2) a policy of blanket accident and health insurance
79	79	as described by Chapter 1251;
80	80	(3) a policy of individual accident and health
81	81	insurance as defined by Section 1201.001; or
82	82	(4) an evidence of coverage as defined by Section
83	83	843.002.
84	84	(b) This subchapter [chapter] does not apply to an
85	85	individual accident and health insurance policy that is designed to
86	86	fully integrate with other policies through a variable deductible.
87	87	SECTION 4. The change in law made by this Act applies only
88	88	to an insurance policy that is delivered, issued for delivery, or
89	89	renewed on or after January 1, 2016. A policy delivered, issued for
90	90	delivery, or renewed before January 1, 2016, is governed by the law
91	91	as it existed immediately before the effective date of this Act, and
92	92	that law is continued in effect for that purpose.
93	93	SECTION 5. This Act takes effect September 1, 2015.