84R4915 KKR-F
By: Hinojosa S.B. No. 1349
A BILL TO BE ENTITLED
AN ACT
relating to coordination of dental benefits under certain insurance
policies.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1203, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. DENTAL INSURANCE
Sec. 1203.051. APPLICABILITY OF SUBCHAPTER. This
subchapter applies only to an insurance policy that provides
benefits for dental expenses, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, or a
group hospital service contract, that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
or
(6) a Lloyd's plan operating under Chapter 941.
Sec. 1203.052. COORDINATION OF BENEFITS BETWEEN PRIMARY AND
SECONDARY PROVIDER. (a) This section applies if:
(1) an insured is covered by at least two different
insurance policies; and
(2) each policy provides the insured dental benefits.
(b) The primary insurer, as determined under a coordination
of benefits provision applicable to the policies, is responsible
for dental expenses covered under the insurance policy issued by
the primary insurer up to the full amount of the applicable policy
limit.
(c) Before the policy limit described by Subsection (b) is
reached, the secondary insurer, as determined under a coordination
of benefits provision applicable to the policies, is responsible
only for dental expenses covered under the insurance policy issued
by the secondary insurer that are not covered under the policy
issued by the primary insurer.
(d) After the policy limit described by Subsection (b) has
been reached, the secondary insurer, in addition to the
responsibility described by Subsection (c), is responsible for any
dental expenses covered by both policies that exceed the policy
limit described by Subsection (b), up to the full amount of the
applicable policy limit of the insurance policy issued by the
secondary insurer.
Sec. 1203.053. CERTAIN COORDINATION OF BENEFITS PROVISIONS
PROHIBITED. An insurance policy subject to this subchapter may not
be delivered, issued for delivery, or renewed in this state if:
(1) a provision of the policy excludes or reduces the
payment of benefits for dental expenses to or on behalf of an
insured;
(2) the reason for the exclusion or reduction is that
dental benefits are payable or have been paid to or on behalf of the
insured under another insurance policy; and
(3) the exclusion or reduction would apply before the
full amount of the dental expenses incurred by the insured and
covered by both policies have been paid or reimbursed or the full
amount of the applicable policy limit of the policy containing the
exclusion or reduction is reached.
Sec. 1203.054. CERTAIN COORDINATION OF BENEFITS PROVISIONS
VOID. A provision of an insurance policy that violates Section
1203.053 is void.
SECTION 2. Chapter 1203, Insurance Code, is amended by
designating Sections 1203.001 through 1203.003 as Subchapter A and
adding a subchapter heading to read as follows:
SUBCHAPTER A. SUPPLEMENTAL INSURANCE POLICIES
SECTION 3. Section 1203.001, Insurance Code, is amended to
read as follows:
Sec. 1203.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. (a)
This subchapter [chapter] applies only to:
(1) a policy of group accident and health insurance as
described by Chapter 1251;
(2) a policy of blanket accident and health insurance
as described by Chapter 1251;
(3) a policy of individual accident and health
insurance as defined by Section 1201.001; or
(4) an evidence of coverage as defined by Section
843.002.
(b) This subchapter [chapter] does not apply to an
individual accident and health insurance policy that is designed to
fully integrate with other policies through a variable deductible.
SECTION 4. The change in law made by this Act applies only
to an insurance policy that is delivered, issued for delivery, or
renewed on or after January 1, 2016. A policy 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 5. This Act takes effect September 1, 2015.