Texas 2017 - 85th Regular

Texas House Bill HB224 Compare Versions

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

Old	New	Differences
1	1	85R3680 MEW-D
2	2	By: Rodriguez of Travis H.B. No. 224
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage of preexisting conditions.
8	8	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
9	9	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
10	10	by adding Chapter 1509 to read as follows:
11	11	CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS
12	12	Sec. 1509.001. DEFINITION. In this chapter, "preexisting
13	13	condition" means a condition present before the effective date of
14	14	an individual's coverage under a health benefit plan.
15	15	Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter
16	16	applies only to a health benefit plan, including a small employer
17	17	health benefit plan written under Chapter 1501 or coverage provided
18	18	through a health group cooperative under Subchapter B of that
19	19	chapter, that provides benefits for medical or surgical expenses
20	20	incurred as a result of a health condition, accident, or sickness,
21	21	including an individual, group, blanket, or franchise insurance
22	22	policy or insurance agreement, a group hospital service contract,
23	23	or an individual or group evidence of coverage or similar coverage
24	24	document that is offered by:
25	25	(1) an insurance company;
26	26	(2) a group hospital service corporation operating
27	27	under Chapter 842;
28	28	(3) a fraternal benefit society operating under
29	29	Chapter 885;
30	30	(4) a Lloyd's plan operating under Chapter 941;
31	31	(5) a stipulated premium insurance company operating
32	32	under Chapter 884;
33	33	(6) a reciprocal exchange operating under Chapter 942;
34	34	(7) a health maintenance organization operating under
35	35	Chapter 843;
36	36	(8) a multiple employer welfare arrangement that holds
37	37	a certificate of authority under Chapter 846; or
38	38	(9) an approved nonprofit health corporation that
39	39	holds a certificate of authority under Chapter 844.
40	40	(b) This chapter applies to coverage under a group health
41	41	benefit plan described by Subsection (a) provided to a resident of
42	42	this state, regardless of whether the group policy, agreement, or
43	43	contract is delivered, issued for delivery, or renewed within or
44	44	outside this state.
45	45	(c) This chapter applies to group health coverage made
46	46	available by a school district in accordance with Section 22.004,
47	47	Education Code.
48	48	(d) This chapter applies to a self-funded health benefit
49	49	plan sponsored by a professional employer organization under
50	50	Chapter 91, Labor Code.
51	51	(e) Notwithstanding Section 22.409, Business Organizations
52	52	Code, or any other law, this chapter applies to health benefits
53	53	provided by or through a church benefits board under Subchapter I,
54	54	Chapter 22, Business Organizations Code.
55	55	(f) Notwithstanding Sections 157.008 and 157.106, Local
56	56	Government Code, or any other law, this chapter applies to a county
57	57	employee health benefit plan provided under Chapter 157, Local
58	58	Government Code.
59	59	(g) Notwithstanding Section 75.104, Health and Safety Code,
60	60	or any other law, this chapter applies to a regional or local health
61	61	care program operated under that section.
62	62	(h) Notwithstanding Section 172.014, Local Government Code,
63	63	or any other law, this chapter applies to health and accident
64	64	coverage provided by a risk pool created under Chapter 172, Local
65	65	Government Code.
66	66	(i) Notwithstanding any provision in Chapter 1551, 1575,
67	67	1579, or 1601 or any other law, this chapter applies to:
68	68	(1) a basic coverage plan under Chapter 1551;
69	69	(2) a basic plan under Chapter 1575;
70	70	(3) a primary care coverage plan under Chapter 1579;
71	71	and
72	72	(4) basic coverage under Chapter 1601.
73	73	(j) Notwithstanding any other law, a standard health
74	74	benefit plan provided under Chapter 1507 must provide the coverage
75	75	required by this chapter.
76	76	(k) To the extent allowed by federal law, the child health
77	77	plan program operated under Chapter 62, Health and Safety Code, the
78	78	state Medicaid program, and a managed care organization that
79	79	contracts with the Health and Human Services Commission to provide
80	80	health care services to recipients through a managed care plan
81	81	shall provide the coverage required under this chapter to a
82	82	recipient.
83	83	Sec. 1509.003. EXCEPTIONS. (a) This chapter does not apply
84	84	to:
85	85	(1) a plan that provides coverage:
86	86	(A) for wages or payments in lieu of wages for a
87	87	period during which an employee is absent from work because of
88	88	sickness or injury;
89	89	(B) as a supplement to a liability insurance
90	90	policy;
91	91	(C) for credit insurance;
92	92	(D) only for dental or vision care;
93	93	(E) only for hospital expenses; or
94	94	(F) only for indemnity for hospital confinement;
95	95	(2) a Medicare supplemental policy as defined by
96	96	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
97	97	1395ss(g)(1));
98	98	(3) a workers' compensation insurance policy;
99	99	(4) medical payment insurance coverage provided under
100	100	a motor vehicle insurance policy; or
101	101	(5) a long-term care policy, including a nursing home
102	102	fixed indemnity policy, unless the commissioner determines that the
103	103	policy provides benefit coverage so comprehensive that the policy
104	104	is a health benefit plan as described by Section 1509.002.
105	105	(b) This chapter does not apply to an individual health
106	106	benefit plan issued on or before March 23, 2010, that has not had
107	107	any significant changes since that date that reduce benefits or
108	108	increase costs to the individual.
109	109	Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS
110	110	PROHIBITED. Notwithstanding any other law, a health benefit plan
111	111	issuer may not:
112	112	(1) deny an individual's application for coverage or
113	113	refuse to enroll an individual in a group health benefit plan due to
114	114	a preexisting condition;
115	115	(2) limit or exclude coverage under the health benefit
116	116	plan for the treatment of a preexisting condition otherwise covered
117	117	under the plan; or
118	118	(3) charge the individual more for coverage than the
119	119	health benefit plan issuer charges an individual who does not have a
120	120	preexisting condition.
121	121	SECTION 2. The change in law made by this Act applies only
122	122	to a health benefit plan that is delivered, issued for delivery, or
123	123	renewed on or after January 1, 2018. A health benefit plan that is
124	124	delivered, issued for delivery, or renewed before January 1, 2018,
125	125	is governed by the law as it existed immediately before the
126	126	effective date of this Act, and that law is continued in effect for
127	127	that purpose.
128	128	SECTION 3. This Act takes effect September 1, 2017.