Texas 2017 - 85th Regular

Texas House Bill HB4218 Compare Versions

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

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1	1	By: Coleman H.B. No. 4218
2	2
3	3
4	4	A BILL TO BE ENTITLED
5	5	AN ACT
6	6	relating to health benefit plan coverage in this state.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	ARTICLE 1. HEALTH BENEFIT AFFORDABILITY AND ACCESSIBILITY
9	9	SECTION 1.01. Subtitle A, Title 8, Insurance Code, is
10	10	amended by adding Chapter 1218 to read as follows:
11	11	CHAPTER 1218. HEALTH BENEFIT AFFORDABILITY AND ACCESSIBILITY
12	12	SUBCHAPTER A. GENERAL PROVISIONS
13	13	Sec. 1218.001. APPLICABILITY OF CHAPTER. (a) This chapter
14	14	applies only to a health benefit plan that provides benefits for
15	15	medical or surgical expenses incurred as a result of a health
16	16	condition, accident, or sickness, including an individual, group,
17	17	blanket, or franchise insurance policy or insurance agreement, a
18	18	group hospital service contract, or an individual or group evidence
19	19	of coverage or similar coverage document that is issued by:
20	20	(1) an insurance company;
21	21	(2) a group hospital service corporation operating
22	22	under Chapter 842;
23	23	(3) a health maintenance organization operating under
24	24	Chapter 843;
25	25	(4) an approved nonprofit health corporation that
26	26	holds a certificate of authority under Chapter 844;
27	27	(5) a multiple employer welfare arrangement that holds
28	28	a certificate of authority under Chapter 846;
29	29	(6) a stipulated premium company operating under
30	30	Chapter 884;
31	31	(7) a fraternal benefit society operating under
32	32	Chapter 885;
33	33	(8) a Lloyd's plan operating under Chapter 941; or
34	34	(9) an exchange operating under Chapter 942.
35	35	(b) Notwithstanding any other law, this chapter applies to:
36	36	(1) a small employer health benefit plan subject to
37	37	Chapter 1501, including coverage provided through a health group
38	38	cooperative under Subchapter B of that chapter;
39	39	(2) a standard health benefit plan issued under
40	40	Chapter 1507;
41	41	(3) a basic coverage plan under Chapter 1551;
42	42	(4) a basic plan under Chapter 1575;
43	43	(5) a primary care coverage plan under Chapter 1579;
44	44	(6) a plan providing basic coverage under Chapter
45	45	1601;
46	46	(7) health benefits provided by or through a church
47	47	benefits board under Subchapter I, Chapter 22, Business
48	48	Organizations Code;
49	49	(8) group health coverage made available by a school
50	50	district in accordance with Section 22.004, Education Code;
51	51	(9) the state Medicaid program, including the Medicaid
52	52	managed care program operated under Chapter 533, Government Code;
53	53	(10) the child health plan program under Chapter 62,
54	54	Health and Safety Code;
55	55	(11) a regional or local health care program operated
56	56	under Section 75.104, Health and Safety Code;
57	57	(12) a self-funded health benefit plan sponsored by a
58	58	professional employer organization under Chapter 91, Labor Code;
59	59	(13) county employee group health benefits provided
60	60	under Chapter 157, Local Government Code; and
61	61	(14) health and accident coverage provided by a risk
62	62	pool created under Chapter 172, Local Government Code.
63	63	(c) This chapter applies to coverage under a group health
64	64	benefit plan provided to a resident of this state regardless of
65	65	whether the group policy, agreement, or contract is delivered,
66	66	issued for delivery, or renewed in this state.
67	67	Sec. 1218.002. EXCEPTIONS. (a) This chapter does not apply
68	68	to:
69	69	(1) a plan that provides coverage:
70	70	(A) for wages or payments in lieu of wages for a
71	71	period during which an employee is absent from work because of
72	72	sickness or injury;
73	73	(B) as a supplement to a liability insurance
74	74	policy;
75	75	(C) for credit insurance;
76	76	(D) only for dental or vision care;
77	77	(E) only for hospital expenses; or
78	78	(F) only for indemnity for hospital confinement;
79	79	(2) a Medicare supplemental policy as defined by
80	80	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
81	81	1395ss(g)(1));
82	82	(3) a workers' compensation insurance policy;
83	83	(4) medical payment insurance coverage provided under
84	84	a motor vehicle insurance policy; or
85	85	(5) a long-term care policy, including a nursing home
86	86	fixed indemnity policy, unless the commissioner determines that the
87	87	policy provides benefit coverage so comprehensive that the policy
88	88	is a health benefit plan as described by Section 1218.001.
89	89	(b) This chapter does not apply to an individual health
90	90	benefit plan issued on or before March 23, 2010, that has not had
91	91	any significant changes since that date that reduce benefits or
92	92	increase costs to the individual.
93	93	Sec. 1218.003. CONFLICT WITH OTHER LAW. If this chapter
94	94	conflicts with another law relating to lifetime or annual benefit
95	95	limits or the imposition of a premium, deductible, copayment,
96	96	coinsurance, or other cost-sharing provision, this chapter
97	97	controls.
98	98	SUBCHAPTER B. CERTAIN COST-SHARING AND COVERAGE AMOUNT LIMITS
99	99	PROHIBITED
100	100	Sec. 1218.051. CERTAIN COST-SHARING PROVISIONS FOR
101	101	PREVENTIVE SERVICES PROHIBITED. A health benefit plan issuer may
102	102	not impose a deductible, copayment, coinsurance, or other
103	103	cost-sharing provision applicable to benefits for:
104	104	(1) a preventive item or service that has in effect a
105	105	rating of "A" or "B" in the most recent recommendations of the
106	106	United States Preventive Services Task Force;
107	107	(2) an immunization recommended for routine use in the
108	108	most recent immunization schedules published by the United States
109	109	Centers for Disease Control and Prevention of the United States
110	110	Public Health Service; or
111	111	(3) preventive care and screenings supported by the
112	112	most recent comprehensive guidelines adopted by the United States
113	113	Health Resources and Services Administration.
114	114	Sec. 1218.052. CERTAIN ANNUAL AND LIFETIME LIMITS
115	115	PROHIBITED. A health benefit plan issuer may not establish an
116	116	annual or lifetime benefit amount for an enrollee in relation to
117	117	essential health benefits listed in 42 U.S.C. Section 18022(b)(1),
118	118	as that section existed on January 1, 2017, and other benefits
119	119	identified by the United States secretary of health and human
120	120	services as essential health benefits as of that date.
121	121	Sec. 1218.053. LIMITATIONS ON COST-SHARING. A health
122	122	benefit plan issuer may not impose cost-sharing requirements that
123	123	exceed the limits established in 42 U.S.C. Section 18022(c)(1) in
124	124	relation to essential health benefits listed in 42 U.S.C. Section
125	125	18022(b)(1), as those sections existed on January 1, 2017, and
126	126	other benefits identified by the United States secretary of health
127	127	and human services as essential health benefits as of that date.
128	128	Sec. 1218.054. DISCRIMINATION BASED ON GENDER PROHIBITED.
129	129	A health benefit plan issuer may not charge an individual a higher
130	130	premium rate based on the individual's gender.
131	131	SUBCHAPTER C. COVERAGE OF PREEXISTING CONDITIONS
132	132	Sec. 1218.101. DEFINITION. In this subchapter,
133	133	"preexisting condition" means a condition present before the
134	134	effective date of an individual's coverage under a health benefit
135	135	plan.
136	136	Sec. 1218.102. PREEXISTING CONDITION RESTRICTIONS
137	137	PROHIBITED. Notwithstanding any other law, a health benefit plan
138	138	issuer may not:
139	139	(1) deny an individual's application for coverage or
140	140	refuse to enroll an individual in a health benefit plan due to a
141	141	preexisting condition;
142	142	(2) limit or exclude coverage under the health benefit
143	143	plan for the treatment of a preexisting condition otherwise covered
144	144	under the plan; or
145	145	(3) charge the individual more for coverage than the
146	146	health benefit plan issuer charges an individual who does not have a
147	147	preexisting condition.
148	148	SUBCHAPTER D. EXTERNAL REVIEW PROCEDURE
149	149	Sec. 1218.151. EXTERNAL REVIEW MODEL ACT RULES. (a) The
150	150	department shall adopt rules as necessary to conform Texas law with
151	151	the requirements of the NAIC Uniform Health Carrier External Review
152	152	Model Act (April 2010).
153	153	(b) To the extent that the rules adopted under this section
154	154	conflict with Chapter 843 or Title 14, the rules control.
155	155	ARTICLE 2. HEALTH BENEFIT PLAN COVERAGE FOR MENTAL HEALTH
156	156	CONDITIONS AND SUBSTANCE USE DISORDERS
157	157	SECTION 2.01. Chapter 1355, Insurance Code, is amended by
158	158	adding Subchapter F to read as follows:
159	159	SUBCHAPTER F. COVERAGE FOR MENTAL HEALTH CONDITIONS AND SUBSTANCE
160	160	USE DISORDERS
161	161	Sec. 1355.251. DEFINITIONS. In this subchapter:
162	162	(1) "Financial requirement" includes a requirement
163	163	relating to a deductible, copayment, coinsurance, or other
164	164	out-of-pocket expense or an annual or lifetime limit.
165	165	(2) "Mental health benefit" means a benefit relating
166	166	to an item or service for a mental health condition, as defined
167	167	under the terms of a health benefit plan and in accordance with
168	168	applicable federal and state law.
169	169	(3) "Nonquantitative treatment limitation" includes:
170	170	(A) a medical management standard limiting or
171	171	excluding benefits based on medical necessity or medical
172	172	appropriateness or based on whether a treatment is experimental or
173	173	investigational;
174	174	(B) formulary design for prescription drugs;
175	175	(C) network tier design;
176	176	(D) a standard for provider participation in a
177	177	network, including reimbursement rates;
178	178	(E) a method used by a health benefit plan to
179	179	determine usual, customary, and reasonable charges;
180	180	(F) a step therapy protocol;
181	181	(G) an exclusion based on failure to complete a
182	182	course of treatment; and
183	183	(H) a restriction based on geographic location,
184	184	facility type, provider specialty, and other criteria that limit
185	185	the scope or duration of a benefit.
186	186	(4) "Substance use disorder benefit" means a benefit
187	187	relating to an item or service for a substance use disorder, as
188	188	defined under the terms of a health benefit plan and in accordance
189	189	with applicable federal and state law.
190	190	(5) "Treatment limitation" includes a limit on the
191	191	frequency of treatment, number of visits, days of coverage, or
192	192	other similar limit on the scope or duration of treatment. The term
193	193	includes a nonquantitative treatment limitation.
194	194	Sec. 1355.252. APPLICABILITY OF SUBCHAPTER. (a) This
195	195	subchapter applies only to a health benefit plan that provides
196	196	benefits for medical or surgical expenses incurred as a result of a
197	197	health condition, accident, or sickness, including an individual,
198	198	group, blanket, or franchise insurance policy or insurance
199	199	agreement, a group hospital service contract, or an individual or
200	200	group evidence of coverage or similar coverage document that is
201	201	issued by:
202	202	(1) an insurance company;
203	203	(2) a group hospital service corporation operating
204	204	under Chapter 842;
205	205	(3) a health maintenance organization operating under
206	206	Chapter 843;
207	207	(4) an approved nonprofit health corporation that
208	208	holds a certificate of authority under Chapter 844;
209	209	(5) a multiple employer welfare arrangement that holds
210	210	a certificate of authority under Chapter 846;
211	211	(6) a stipulated premium company operating under
212	212	Chapter 884;
213	213	(7) a fraternal benefit society operating under
214	214	Chapter 885;
215	215	(8) a Lloyd's plan operating under Chapter 941; or
216	216	(9) an exchange operating under Chapter 942.
217	217	(b) Notwithstanding any other law, this subchapter applies
218	218	to:
219	219	(1) a small employer health benefit plan subject to
220	220	Chapter 1501, including coverage provided through a health group
221	221	cooperative under Subchapter B of that chapter;
222	222	(2) a standard health benefit plan issued under
223	223	Chapter 1507;
224	224	(3) a basic coverage plan under Chapter 1551;
225	225	(4) a basic plan under Chapter 1575;
226	226	(5) a primary care coverage plan under Chapter 1579;
227	227	(6) a plan providing basic coverage under Chapter
228	228	1601;
229	229	(7) health benefits provided by or through a church
230	230	benefits board under Subchapter I, Chapter 22, Business
231	231	Organizations Code;
232	232	(8) group health coverage made available by a school
233	233	district in accordance with Section 22.004, Education Code;
234	234	(9) the state Medicaid program, including the Medicaid
235	235	managed care program operated under Chapter 533, Government Code;
236	236	(10) the child health plan program under Chapter 62,
237	237	Health and Safety Code;
238	238	(11) a regional or local health care program operated
239	239	under Section 75.104, Health and Safety Code;
240	240	(12) a self-funded health benefit plan sponsored by a
241	241	professional employer organization under Chapter 91, Labor Code;
242	242	(13) county employee group health benefits provided
243	243	under Chapter 157, Local Government Code; and
244	244	(14) health and accident coverage provided by a risk
245	245	pool created under Chapter 172, Local Government Code.
246	246	(c) This subchapter applies to coverage under a group health
247	247	benefit plan provided to a resident of this state regardless of
248	248	whether the group policy, agreement, or contract is delivered,
249	249	issued for delivery, or renewed in this state.
250	250	Sec. 1355.253. EXCEPTION. This subchapter does not apply
251	251	to an individual health benefit plan issued on or before March 23,
252	252	2010, that has not had any significant changes since that date that
253	253	reduce benefits or increase costs to the individual.
254	254	Sec. 1355.254. REQUIRED COVERAGE FOR MENTAL HEALTH
255	255	CONDITIONS AND SUBSTANCE USE DISORDERS. (a) A health benefit plan
256	256	must provide benefits for mental health conditions and substance
257	257	use disorders under the same terms and conditions applicable to
258	258	benefits for medical or surgical expenses.
259	259	(b) Coverage under Subsection (a) may not impose treatment
260	260	limitations or financial requirements on benefits for a mental
261	261	health condition or substance use disorder that are generally more
262	262	restrictive than treatment limitations or financial requirements
263	263	imposed on coverage of benefits for medical or surgical expenses.
264	264	Sec. 1355.255. DEFINITIONS UNDER PLAN. (a) A health
265	265	benefit plan must define a condition to be a mental health condition
266	266	or not a mental health condition in a manner consistent with
267	267	generally recognized independent standards of medical practice.
268	268	(b) A health benefit plan must define a condition to be a
269	269	substance use disorder or not a substance use disorder in a manner
270	270	consistent with generally recognized independent standards of
271	271	medical practice.
272	272	Sec. 1355.256. COORDINATION WITH OTHER LAW; INTENT OF
273	273	LEGISLATURE. This subchapter supplements Subchapters A and B of
274	274	this chapter and Chapter 1368 and the department rules adopted
275	275	under those statutes. It is the intent of the legislature that
276	276	Subchapter A or B of this chapter or Chapter 1368 or the department
277	277	rules adopted under those statutes controls in any circumstance in
278	278	which that other law requires:
279	279	(1) a benefit that is not required by this subchapter;
280	280	or
281	281	(2) a more extensive benefit than is required by this
282	282	subchapter.
283	283	Sec. 1355.257. RULES. The commissioner shall adopt rules
284	284	necessary to implement this subchapter.
285	285	ARTICLE 3. COVERAGE OF ESSENTIAL HEALTH BENEFITS
286	286	SECTION 3.01. Subtitle E, Title 8, Insurance Code, is
287	287	amended by adding Chapter 1380 to read as follows:
288	288	CHAPTER 1380. COVERAGE OF ESSENTIAL HEALTH BENEFITS
289	289	Sec. 1380.001. APPLICABILITY OF CHAPTER. (a) This chapter
290	290	applies only to a health benefit plan that provides benefits for
291	291	medical or surgical expenses incurred as a result of a health
292	292	condition, accident, or sickness, including an individual, group,
293	293	blanket, or franchise insurance policy or insurance agreement, a
294	294	group hospital service contract, or an individual or group evidence
295	295	of coverage or similar coverage document that is issued by:
296	296	(1) an insurance company;
297	297	(2) a group hospital service corporation operating
298	298	under Chapter 842;
299	299	(3) a health maintenance organization operating under
300	300	Chapter 843;
301	301	(4) an approved nonprofit health corporation that
302	302	holds a certificate of authority under Chapter 844;
303	303	(5) a multiple employer welfare arrangement that holds
304	304	a certificate of authority under Chapter 846;
305	305	(6) a stipulated premium company operating under
306	306	Chapter 884;
307	307	(7) a fraternal benefit society operating under
308	308	Chapter 885;
309	309	(8) a Lloyd's plan operating under Chapter 941; or
310	310	(9) an exchange operating under Chapter 942.
311	311	(b) Notwithstanding any other law, this chapter applies to:
312	312	(1) a small employer health benefit plan subject to
313	313	Chapter 1501, including coverage provided through a health group
314	314	cooperative under Subchapter B of that chapter;
315	315	(2) a standard health benefit plan issued under
316	316	Chapter 1507;
317	317	(3) a basic coverage plan under Chapter 1551;
318	318	(4) a basic plan under Chapter 1575;
319	319	(5) a primary care coverage plan under Chapter 1579;
320	320	(6) a plan providing basic coverage under Chapter
321	321	1601;
322	322	(7) health benefits provided by or through a church
323	323	benefits board under Subchapter I, Chapter 22, Business
324	324	Organizations Code;
325	325	(8) group health coverage made available by a school
326	326	district in accordance with Section 22.004, Education Code;
327	327	(9) the state Medicaid program, including the Medicaid
328	328	managed care program operated under Chapter 533, Government Code;
329	329	(10) the child health plan program under Chapter 62,
330	330	Health and Safety Code;
331	331	(11) a regional or local health care program operated
332	332	under Section 75.104, Health and Safety Code;
333	333	(12) a self-funded health benefit plan sponsored by a
334	334	professional employer organization under Chapter 91, Labor Code;
335	335	(13) county employee group health benefits provided
336	336	under Chapter 157, Local Government Code; and
337	337	(14) health and accident coverage provided by a risk
338	338	pool created under Chapter 172, Local Government Code.
339	339	(c) This chapter applies to coverage under a group health
340	340	benefit plan provided to a resident of this state regardless of
341	341	whether the group policy, agreement, or contract is delivered,
342	342	issued for delivery, or renewed in this state.
343	343	Sec. 1380.002. EXCEPTION. This chapter does not apply to an
344	344	individual health benefit plan issued on or before March 23, 2010,
345	345	that has not had any significant changes since that date that reduce
346	346	benefits or increase costs to the individual.
347	347	Sec. 1380.003. REQUIRED COVERAGE FOR ESSENTIAL HEALTH
348	348	BENEFITS. A health benefit plan must provide coverage for the
349	349	essential health benefits listed in 42 U.S.C. Section 18022(b)(1),
350	350	as that section existed on January 1, 2017, and other benefits
351	351	identified by the United States secretary of health and human
352	352	services as essential health benefits as of that date.
353	353	ARTICLE 4. HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN YOUNG ADULTS
354	354	SECTION 4.01. Subchapter A, Chapter 533, Government Code,
355	355	is amended by adding Section 533.0054 to read as follows:
356	356	Sec. 533.0054. ELIGIBILITY AGE FOR STAR HEALTH COVERAGE. A
357	357	child enrolled in the STAR Health Medicaid managed care program is
358	358	eligible to receive health care services under the program until
359	359	the child is 26 years of age.
360	360	SECTION 4.02. Section 846.260, Insurance Code, is amended
361	361	to read as follows:
362	362	Sec. 846.260. LIMITING AGE APPLICABLE TO UNMARRIED CHILD.
363	363	If children are eligible for coverage under the terms of a multiple
364	364	employer welfare arrangement's plan document, any limiting age
365	365	applicable to an unmarried child of an enrollee is 26 [25] years of
366	366	age.
367	367	SECTION 4.03. Section 1201.053(b), Insurance Code, as
368	368	effective until September 1, 2018, is amended to read as follows:
369	369	(b) On the application of an adult member of a family, an
370	370	individual accident and health insurance policy may, at the time of
371	371	original issuance or by subsequent amendment, insure two or more
372	372	eligible members of the adult's family, including a spouse,
373	373	unmarried children younger than 26 [25] years of age, including a
374	374	grandchild of the adult as described by Section 1201.062(a)(1), a
375	375	child the adult is required to insure under a medical support order
376	376	issued under Chapter 154, Family Code, or enforceable by a court in
377	377	this state, and any other individual dependent on the adult.
378	378	SECTION 4.04. Section 1201.053(b), Insurance Code, as
379	379	effective September 1, 2018, is amended to read as follows:
380	380	(b) On the application of an adult member of a family, an
381	381	individual accident and health insurance policy may, at the time of
382	382	original issuance or by subsequent amendment, insure two or more
383	383	eligible members of the adult's family, including a spouse,
384	384	unmarried children younger than 26 [25] years of age, including a
385	385	grandchild of the adult as described by Section 1201.062(a)(1), a
386	386	child the adult is required to insure under a medical support order
387	387	or dental support order, if the policy provides dental coverage,
388	388	issued under Chapter 154, Family Code, or enforceable by a court in
389	389	this state, and any other individual dependent on the adult.
390	390	SECTION 4.05. Section 1201.062(a), Insurance Code, as
391	391	effective until September 1, 2018, is amended to read as follows:
392	392	(a) An individual or group accident and health insurance
393	393	policy that is delivered, issued for delivery, or renewed in this
394	394	state, including a policy issued by a corporation operating under
395	395	Chapter 842, or a self-funded or self-insured welfare or benefit
396	396	plan or program, to the extent that regulation of the plan or
397	397	program is not preempted by federal law, that provides coverage for
398	398	a child of an insured or group member, on payment of a premium, must
399	399	provide coverage for:
400	400	(1) each grandchild of the insured or group member if
401	401	the grandchild is:
402	402	(A) unmarried;
403	403	(B) younger than 26 [25] years of age; and
404	404	(C) a dependent of the insured or group member
405	405	for federal income tax purposes at the time application for
406	406	coverage of the grandchild is made; and
407	407	(2) each child for whom the insured or group member
408	408	must provide medical support under an order issued under Chapter
409	409	154, Family Code, or enforceable by a court in this state.
410	410	SECTION 4.06. Section 1201.062(a), Insurance Code, as
411	411	effective September 1, 2018, is amended to read as follows:
412	412	(a) An individual or group accident and health insurance
413	413	policy that is delivered, issued for delivery, or renewed in this
414	414	state, including a policy issued by a corporation operating under
415	415	Chapter 842, or a self-funded or self-insured welfare or benefit
416	416	plan or program, to the extent that regulation of the plan or
417	417	program is not preempted by federal law, that provides coverage for
418	418	a child of an insured or group member, on payment of a premium, must
419	419	provide coverage for:
420	420	(1) each grandchild of the insured or group member if
421	421	the grandchild is:
422	422	(A) unmarried;
423	423	(B) younger than 26 [25] years of age; and
424	424	(C) a dependent of the insured or group member
425	425	for federal income tax purposes at the time application for
426	426	coverage of the grandchild is made; and
427	427	(2) each child for whom the insured or group member
428	428	must provide medical support or dental support, if the policy
429	429	provides dental coverage, under an order issued under Chapter 154,
430	430	Family Code, or enforceable by a court in this state.
431	431	SECTION 4.07. Section 1201.065(a), Insurance Code, is
432	432	amended to read as follows:
433	433	(a) An individual or group accident and health insurance
434	434	policy may contain criteria relating to a maximum age or enrollment
435	435	in school to establish continued eligibility for coverage of a
436	436	child 26 [25] years of age or older.
437	437	SECTION 4.08. Section 1251.151(a), Insurance Code, is
438	438	amended to read as follows:
439	439	(a) A group policy or contract of insurance for hospital,
440	440	surgical, or medical expenses incurred as a result of accident or
441	441	sickness, including a group contract issued by a group hospital
442	442	service corporation, that provides coverage under the policy or
443	443	contract for a child of an insured must, on payment of a premium,
444	444	provide coverage for any grandchild of the insured if the
445	445	grandchild is:
446	446	(1) unmarried;
447	447	(2) younger than 26 [25] years of age; and
448	448	(3) a dependent of the insured for federal income tax
449	449	purposes at the time the application for coverage of the grandchild
450	450	is made.
451	451	SECTION 4.09. Section 1251.152(a), Insurance Code, is
452	452	amended to read as follows:
453	453	(a) For purposes of this section, "dependent" includes:
454	454	(1) a child of an employee or member who is:
455	455	(A) unmarried; and
456	456	(B) younger than 26 [25] years of age; and
457	457	(2) a grandchild of an employee or member who is:
458	458	(A) unmarried;
459	459	(B) younger than 26 [25] years of age; and
460	460	(C) a dependent of the insured for federal income
461	461	tax purposes at the time the application for coverage of the
462	462	grandchild is made.
463	463	SECTION 4.10. Section 1271.006(a), Insurance Code, is
464	464	amended to read as follows:
465	465	(a) If children are eligible for coverage under the terms of
466	466	an evidence of coverage, any limiting age applicable to an
467	467	unmarried child of an enrollee, including an unmarried grandchild
468	468	of an enrollee, is 26 [25] years of age. The limiting age
469	469	applicable to a child must be stated in the evidence of coverage.
470	470	SECTION 4.11. Section 1501.002(2), Insurance Code, is
471	471	amended to read as follows:
472	472	(2) "Dependent" means:
473	473	(A) a spouse;
474	474	(B) a child younger than 26 [25] years of age,
475	475	including a newborn child;
476	476	(C) a child of any age who is:
477	477	(i) medically certified as disabled; and
478	478	(ii) dependent on the parent;
479	479	(D) an individual who must be covered under:
480	480	(i) Section 1251.154; or
481	481	(ii) Section 1201.062; and
482	482	(E) any other child eligible under an employer's
483	483	health benefit plan, including a child described by Section
484	484	1503.003.
485	485	SECTION 4.12. Section 1501.609(b), Insurance Code, is
486	486	amended to read as follows:
487	487	(b) Any limiting age applicable under a large employer
488	488	health benefit plan to an unmarried child of an enrollee is 26 [25]
489	489	years of age.
490	490	SECTION 4.13. Sections 1503.003(a) and (b), Insurance Code,
491	491	are amended to read as follows:
492	492	(a) A health benefit plan may not condition coverage for a
493	493	child younger than 26 [25] years of age on the child's being
494	494	enrolled at an educational institution.
495	495	(b) A health benefit plan that requires as a condition of
496	496	coverage for a child 26 [25] years of age or older that the child be
497	497	a full-time student at an educational institution must provide the
498	498	coverage:
499	499	(1) for the entire academic term during which the
500	500	child begins as a full-time student and remains enrolled,
501	501	regardless of whether the number of hours of instruction for which
502	502	the child is enrolled is reduced to a level that changes the child's
503	503	academic status to less than that of a full-time student; and
504	504	(2) continuously until the 10th day of instruction of
505	505	the subsequent academic term, on which date the health benefit plan
506	506	may terminate coverage for the child if the child does not return to
507	507	full-time student status before that date.
508	508	SECTION 4.14. Section 1601.004(a), Insurance Code, is
509	509	amended to read as follows:
510	510	(a) In this chapter, "dependent," with respect to an
511	511	individual eligible to participate in the uniform program under
512	512	Section 1601.101 or 1601.102, means the individual's:
513	513	(1) spouse;
514	514	(2) unmarried child younger than 26 [25] years of age;
515	515	and
516	516	(3) child of any age who lives with or has the child's
517	517	care provided by the individual on a regular basis if the child has
518	518	a mental disability or is [mentally retarded or] physically
519	519	incapacitated to the extent that the child is dependent on the
520	520	individual for care or support, as determined by the system.
521	521	ARTICLE 5. TRANSITION; EFFECTIVE DATE
522	522	SECTION 5.01. The change in law made by this Act applies
523	523	only to a health benefit plan that is delivered, issued for
524	524	delivery, or renewed on or after January 1, 2018. A health benefit
525	525	plan that is delivered, issued for delivery, or renewed before
526	526	January 1, 2018, is governed by the law as it existed immediately
527	527	before the effective date of this Act, and that law is continued in
528	528	effect for that purpose.
529	529	SECTION 5.02. If before implementing any provision of this
530	530	Act a state agency determines that a waiver or authorization from a
531	531	federal agency is necessary for implementation of that provision,
532	532	the agency affected by the provision shall request the waiver or
533	533	authorization and may delay implementing that provision until the
534	534	waiver or authorization is granted.
535	535	SECTION 5.03. This Act takes effect September 1, 2017.