85R2228 MEW-D
By: Kolkhorst S.B. No. 552
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage of hearing aids and
cochlear implants for certain individuals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1367, Insurance Code, is amended by
adding Subchapter F to read as follows:
SUBCHAPTER F. HEARING AIDS AND COCHLEAR IMPLANTS
Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter 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 subchapter 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 subchapter applies to group health coverage made
available by a school district in accordance with Section 22.004,
Education Code.
(d) This subchapter 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 subchapter 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 subchapter 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 subchapter 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 subchapter 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 subchapter 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 subchapter.
Sec. 1367.252. EXCEPTION. This subchapter 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);
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy;
(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 1367.251; or
(6) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code.
Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit
plan must provide coverage for the cost of a medically necessary
hearing aid or cochlear implant and related services and supplies
for a covered individual who is 18 years of age or younger.
(b) Coverage required under this section:
(1) must include:
(A) fitting and dispensing services and the
provision of ear molds as necessary to maintain optimal fit of
hearing aids;
(B) any treatment related to hearing aids and
cochlear implants, including coverage for habilitation and
rehabilitation as necessary for educational gain; and
(C) for a cochlear implant, an external speech
processor and controller with necessary components replacement
every three years; and
(2) is limited to:
(A) one hearing aid in each ear every three
years; and
(B) one cochlear implant in each ear with
internal replacement as medically or audiologically necessary.
(c) Except as provided by Subsection (b), coverage required
under this section:
(1) may not be less favorable than coverage for
physical illness generally under the plan;
(2) must be subject to durational limits and
coinsurance factors no less favorable than coverage provided for
physical illness generally under the plan; and
(3) may not be subject to a deductible requirement or
dollar limit.
(d) This section does not apply to a qualified health plan
defined by 45 C.F.R. Section 155.20 if a determination is made under
45 C.F.R. Section 155.170 that:
(1) this subchapter requires the plan to offer
benefits in addition to the essential health benefits required
under 42 U.S.C. Section 18022(b); and
(2) this state must make payments to defray the cost of
the additional benefits mandated by this subchapter.
SECTION 2. The change in law made by this Act applies only
to a health benefit plan delivered, issued for delivery, or renewed
on or after January 1, 2018. A health benefit plan 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.