Texas 2017 - 85th Regular

Texas Senate Bill SB552 Compare Versions

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

Old	New	Differences
1	1	85R2228 MEW-D
2	2	By: Kolkhorst S.B. No. 552
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage of hearing aids and
8	8	cochlear implants for certain individuals.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1367, Insurance Code, is amended by
11	11	adding Subchapter F to read as follows:
12	12	SUBCHAPTER F. HEARING AIDS AND COCHLEAR IMPLANTS
13	13	Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This
14	14	subchapter applies only to a health benefit plan, including a small
15	15	employer health benefit plan written under Chapter 1501 or coverage
16	16	provided through a health group cooperative under Subchapter B of
17	17	that chapter, that provides benefits for medical or surgical
18	18	expenses incurred as a result of a health condition, accident, or
19	19	sickness, including an individual, group, blanket, or franchise
20	20	insurance policy or insurance agreement, a group hospital service
21	21	contract, or an individual or group evidence of coverage or similar
22	22	coverage document that is offered by:
23	23	(1) an insurance company;
24	24	(2) a group hospital service corporation operating
25	25	under Chapter 842;
26	26	(3) a fraternal benefit society operating under
27	27	Chapter 885;
28	28	(4) a Lloyd's plan operating under Chapter 941;
29	29	(5) a stipulated premium insurance company operating
30	30	under Chapter 884;
31	31	(6) a reciprocal exchange operating under Chapter 942;
32	32	(7) a health maintenance organization operating under
33	33	Chapter 843;
34	34	(8) a multiple employer welfare arrangement that holds
35	35	a certificate of authority under Chapter 846; or
36	36	(9) an approved nonprofit health corporation that
37	37	holds a certificate of authority under Chapter 844.
38	38	(b) This subchapter applies to coverage under a group health
39	39	benefit plan described by Subsection (a) provided to a resident of
40	40	this state, regardless of whether the group policy, agreement, or
41	41	contract is delivered, issued for delivery, or renewed within or
42	42	outside this state.
43	43	(c) This subchapter applies to group health coverage made
44	44	available by a school district in accordance with Section 22.004,
45	45	Education Code.
46	46	(d) This subchapter applies to a self-funded health benefit
47	47	plan sponsored by a professional employer organization under
48	48	Chapter 91, Labor Code.
49	49	(e) Notwithstanding Section 22.409, Business Organizations
50	50	Code, or any other law, this subchapter applies to health benefits
51	51	provided by or through a church benefits board under Subchapter I,
52	52	Chapter 22, Business Organizations Code.
53	53	(f) Notwithstanding Sections 157.008 and 157.106, Local
54	54	Government Code, or any other law, this subchapter applies to a
55	55	county employee health benefit plan provided under Chapter 157,
56	56	Local Government Code.
57	57	(g) Notwithstanding Section 75.104, Health and Safety Code,
58	58	or any other law, this subchapter applies to a regional or local
59	59	health care program operated under that section.
60	60	(h) Notwithstanding Section 172.014, Local Government Code,
61	61	or any other law, this subchapter applies to health and accident
62	62	coverage provided by a risk pool created under Chapter 172, Local
63	63	Government Code.
64	64	(i) Notwithstanding any provision in Chapter 1551, 1575,
65	65	1579, or 1601 or any other law, this subchapter applies to:
66	66	(1) a basic coverage plan under Chapter 1551;
67	67	(2) a basic plan under Chapter 1575;
68	68	(3) a primary care coverage plan under Chapter 1579;
69	69	and
70	70	(4) basic coverage under Chapter 1601.
71	71	(j) Notwithstanding any other law, a standard health
72	72	benefit plan provided under Chapter 1507 must provide the coverage
73	73	required by this subchapter.
74	74	Sec. 1367.252. EXCEPTION. This subchapter does not apply
75	75	to:
76	76	(1) a plan that provides coverage:
77	77	(A) for wages or payments in lieu of wages for a
78	78	period during which an employee is absent from work because of
79	79	sickness or injury;
80	80	(B) as a supplement to a liability insurance
81	81	policy;
82	82	(C) for credit insurance;
83	83	(D) only for dental or vision care;
84	84	(E) only for hospital expenses; or
85	85	(F) only for indemnity for hospital confinement;
86	86	(2) a Medicare supplemental policy as defined by
87	87	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
88	88	(3) a workers' compensation insurance policy;
89	89	(4) medical payment insurance coverage provided under
90	90	a motor vehicle insurance policy;
91	91	(5) a long-term care policy, including a nursing home
92	92	fixed indemnity policy, unless the commissioner determines that the
93	93	policy provides benefit coverage so comprehensive that the policy
94	94	is a health benefit plan as described by Section 1367.251; or
95	95	(6) the state Medicaid program, including the Medicaid
96	96	managed care program operated under Chapter 533, Government Code.
97	97	Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit
98	98	plan must provide coverage for the cost of a medically necessary
99	99	hearing aid or cochlear implant and related services and supplies
100	100	for a covered individual who is 18 years of age or younger.
101	101	(b) Coverage required under this section:
102	102	(1) must include:
103	103	(A) fitting and dispensing services and the
104	104	provision of ear molds as necessary to maintain optimal fit of
105	105	hearing aids;
106	106	(B) any treatment related to hearing aids and
107	107	cochlear implants, including coverage for habilitation and
108	108	rehabilitation as necessary for educational gain; and
109	109	(C) for a cochlear implant, an external speech
110	110	processor and controller with necessary components replacement
111	111	every three years; and
112	112	(2) is limited to:
113	113	(A) one hearing aid in each ear every three
114	114	years; and
115	115	(B) one cochlear implant in each ear with
116	116	internal replacement as medically or audiologically necessary.
117	117	(c) Except as provided by Subsection (b), coverage required
118	118	under this section:
119	119	(1) may not be less favorable than coverage for
120	120	physical illness generally under the plan;
121	121	(2) must be subject to durational limits and
122	122	coinsurance factors no less favorable than coverage provided for
123	123	physical illness generally under the plan; and
124	124	(3) may not be subject to a deductible requirement or
125	125	dollar limit.
126	126	(d) This section does not apply to a qualified health plan
127	127	defined by 45 C.F.R. Section 155.20 if a determination is made under
128	128	45 C.F.R. Section 155.170 that:
129	129	(1) this subchapter requires the plan to offer
130	130	benefits in addition to the essential health benefits required
131	131	under 42 U.S.C. Section 18022(b); and
132	132	(2) this state must make payments to defray the cost of
133	133	the additional benefits mandated by this subchapter.
134	134	SECTION 2. The change in law made by this Act applies only
135	135	to a health benefit plan delivered, issued for delivery, or renewed
136	136	on or after January 1, 2018. A health benefit plan delivered,
137	137	issued for delivery, or renewed before January 1, 2018, is governed
138	138	by the law as it existed immediately before the effective date of
139	139	this Act, and that law is continued in effect for that purpose.
140	140	SECTION 3. This Act takes effect September 1, 2017.