85R3680 MEW-D
By: Rodriguez of Travis H.B. No. 224
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage of preexisting conditions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
by adding Chapter 1509 to read as follows:
CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS
Sec. 1509.001. DEFINITION. In this chapter, "preexisting
condition" means a condition present before the effective date of
an individual's coverage under a health benefit plan.
Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan, including a small employer
health benefit plan written under Chapter 1501 or coverage provided
through a health group cooperative under Subchapter B of that
chapter, that provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including an individual, group, blanket, or franchise insurance
policy or insurance agreement, a group hospital service contract,
or an individual or group evidence of coverage or similar coverage
document 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 Lloyd's plan operating under Chapter 941;
(5) a stipulated premium insurance company operating
under Chapter 884;
(6) a reciprocal exchange operating under Chapter 942;
(7) a health maintenance organization operating under
Chapter 843;
(8) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(9) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) This chapter applies to coverage under a group health
benefit plan described by Subsection (a) provided to a resident of
this state, regardless of whether the group policy, agreement, or
contract is delivered, issued for delivery, or renewed within or
outside this state.
(c) This chapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(d) This chapter applies to a self-funded health benefit
plan sponsored by a professional employer organization under
Chapter 91, Labor Code.
(e) Notwithstanding Section 22.409, Business Organizations
Code, or any other law, this chapter applies to health benefits
provided by or through a church benefits board under Subchapter I,
Chapter 22, Business Organizations Code.
(f) Notwithstanding Sections 157.008 and 157.106, Local
Government Code, or any other law, this chapter applies to a county
employee health benefit plan provided under Chapter 157, Local
Government Code.
(g) Notwithstanding Section 75.104, Health and Safety Code,
or any other law, this chapter applies to a regional or local health
care program operated under that section.
(h) Notwithstanding Section 172.014, Local Government Code,
or any other law, this chapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(i) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or any other law, this chapter applies to:
(1) a basic coverage plan under Chapter 1551;
(2) a basic plan under Chapter 1575;
(3) a primary care coverage plan under Chapter 1579;
and
(4) basic coverage under Chapter 1601.
(j) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this chapter.
(k) To the extent allowed by federal law, the child health
plan program operated under Chapter 62, Health and Safety Code, the
state Medicaid program, and a managed care organization that
contracts with the Health and Human Services Commission to provide
health care services to recipients through a managed care plan
shall provide the coverage required under this chapter to a
recipient.
Sec. 1509.003. EXCEPTIONS. (a) This chapter does not apply
to:
(1) a plan that provides coverage:
(A) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(B) as a supplement to a liability insurance
policy;
(C) for credit insurance;
(D) only for dental or vision care;
(E) only for hospital expenses; or
(F) only for indemnity for hospital confinement;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section
1395ss(g)(1));
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(5) a long-term care policy, including a nursing home
fixed indemnity policy, unless the commissioner determines that the
policy provides benefit coverage so comprehensive that the policy
is a health benefit plan as described by Section 1509.002.
(b) This chapter does not apply to an individual health
benefit plan issued on or before March 23, 2010, that has not had
any significant changes since that date that reduce benefits or
increase costs to the individual.
Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS
PROHIBITED. Notwithstanding any other law, a health benefit plan
issuer may not:
(1) deny an individual's application for coverage or
refuse to enroll an individual in a group health benefit plan due to
a preexisting condition;
(2) limit or exclude coverage under the health benefit
plan for the treatment of a preexisting condition otherwise covered
under the plan; or
(3) charge the individual more for coverage than the
health benefit plan issuer charges an individual who does not have a
preexisting condition.
SECTION 2. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2018. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2018,
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 3. This Act takes effect September 1, 2017.