Texas 2019 - 86th Regular

Texas House Bill HB2658 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		86R4681 PMO-D
2	2		By: J. Johnson of Dallas, Lucio III, H.B. No. 2658
3		-	González of Dallas~~, Guillen~~
	3	+	González of Dallas
4	4
5	5
6	6		A BILL TO BE ENTITLED
7	7		AN ACT
8	8		relating to health benefit coverage for hearing aids for children
9	9		and adults.
10	10		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11		SECTION 1. Sections 1365.001 through 1365.004, Insurance
12	12		Code, are designated as Subchapter A, Chapter 1365, Insurance Code,
13	13		and a heading is added to Subchapter A to read as follows:
14	14		SUBCHAPTER A. GENERAL PROVISIONS
15	15		SECTION 2. Sections 1365.001 and 1365.002, Insurance Code,
16	16		are amended to read as follows:
17	17		Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
18	18		subchapter [chapter] applies only to a group health benefit plan
19	19		that provides hospital and medical coverage on an expense-incurred,
20	20		service, or prepaid basis, including a group policy, contract, or
21	21		plan that is offered in this state by:
22	22		(1) an insurer;
23	23		(2) a group hospital service corporation operating
24	24		under Chapter 842; or
25	25		(3) a health maintenance organization operating under
26	26		Chapter 843.
27	27		Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
28	28		LAW. The provisions of Chapter 1201, including provisions relating
29	29		to the applicability, purpose, and enforcement of that chapter,
30	30		construction of policies under that chapter, rulemaking under that
31	31		chapter, and definitions of terms applicable in that chapter, apply
32	32		to this subchapter [chapter].
33	33		SECTION 3. Chapter 1365, Insurance Code, is amended by
34	34		adding Subchapter B to read as follows:
35	35		SUBCHAPTER B. HEARING AID COVERAGE
36	36		Sec. 1365.051. APPLICABILITY. (a) This subchapter applies
37	37		only to a health benefit plan, including a small employer health
38	38		benefit plan written under Chapter 1501 or coverage provided
39	39		through a health group cooperative under Subchapter B of that
40	40		chapter, that provides benefits for medical or surgical expenses
41	41		incurred as a result of a health condition, accident, or sickness,
42	42		including an individual, group, blanket, or franchise insurance
43	43		policy or insurance agreement, a group hospital service contract,
44	44		or an individual or group evidence of coverage or similar coverage
45	45		document that is offered by:
46	46		(1) an insurance company;
47	47		(2) a group hospital service corporation operating
48	48		under Chapter 842;
49	49		(3) a fraternal benefit society operating under
50	50		Chapter 885;
51	51		(4) a Lloyd's plan operating under Chapter 941;
52	52		(5) a stipulated premium insurance company operating
53	53		under Chapter 884;
54	54		(6) a reciprocal exchange operating under Chapter 942;
55	55		(7) a health maintenance organization operating under
56	56		Chapter 843;
57	57		(8) a multiple employer welfare arrangement that holds
58	58		a certificate of authority under Chapter 846; or
59	59		(9) an approved nonprofit health corporation that
60	60		holds a certificate of authority under Chapter 844.
61	61		(b) This subchapter applies to coverage under a group health
62	62		benefit plan described by Subsection (a) provided to a resident of
63	63		this state, regardless of whether the group policy, agreement, or
64	64		contract is delivered, issued for delivery, or renewed within or
65	65		outside this state.
66	66		(c) This subchapter applies to a self-funded health benefit
67	67		plan sponsored by a professional employer organization under
68	68		Chapter 91, Labor Code.
69	69		(d) Notwithstanding Section 22.409, Business Organizations
70	70		Code, or any other law, this subchapter applies to health benefits
71	71		provided by or through a church benefits board under Subchapter I,
72	72		Chapter 22, Business Organizations Code.
73	73		(e) Notwithstanding Section 75.104, Health and Safety Code,
74	74		or any other law, this subchapter applies to a regional or local
75	75		health care program operated under that section.
76	76		(f) Notwithstanding any other law, a standard health
77	77		benefit plan provided under Chapter 1507 must provide the coverage
78	78		required by this subchapter.
79	79		(g) Notwithstanding any provision in Chapter 1551, 1575,
80	80		1579, or 1601 or any other law, this subchapter applies to:
81	81		(1) a basic coverage plan under Chapter 1551;
82	82		(2) a basic plan under Chapter 1575;
83	83		(3) a primary care coverage plan under Chapter 1579;
84	84		and
85	85		(4) basic coverage under Chapter 1601.
86	86		Sec. 1365.052. EXCEPTION. (a) This subchapter does not
87	87		apply to:
88	88		(1) a plan that provides coverage:
89	89		(A) for wages or payments in lieu of wages for a
90	90		period during which an employee is absent from work because of
91	91		sickness or injury;
92	92		(B) as a supplement to a liability insurance
93	93		policy;
94	94		(C) for credit insurance;
95	95		(D) only for dental or vision care;
96	96		(E) only for hospital expenses; or
97	97		(F) only for indemnity for hospital confinement;
98	98		(2) a Medicare supplemental policy as defined by
99	99		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
100	100		(3) a workers' compensation insurance policy;
101	101		(4) medical payment insurance coverage provided under
102	102		a motor vehicle insurance policy;
103	103		(5) a long-term care policy, including a nursing home
104	104		fixed indemnity policy, unless the commissioner determines that the
105	105		policy provides benefit coverage so comprehensive that the policy
106	106		is a health benefit plan as described by Section 1367.251; or
107	107		(6) the state Medicaid program, including the Medicaid
108	108		managed care program operated under Chapter 533, Government Code.
109	109		(b) This subchapter does not apply to a qualified health
110	110		plan defined by 45 C.F.R. Section 155.20 if a determination is made
111	111		under 45 C.F.R. Section 155.170 that:
112	112		(1) this subchapter requires the plan to offer
113	113		benefits in addition to the essential health benefits required
114	114		under 42 U.S.C. Section 18022(b); and
115	115		(2) this state must make payments to defray the cost of
116	116		the additional benefits mandated by this subchapter.
117	117		Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit
118	118		plan that provides coverage for hearing aids may not deny an
119	119		enrollee's claim for a hearing aid solely on the basis that the
120	120		price of the hearing aid is more than the benefit available under
121	121		the health benefit plan.
122	122		(b) Notwithstanding Section 1367.253(d), this section
123	123		applies to a health benefit plan subject to Subchapter F, Chapter
124	124		1367.
125	125		(c) Nothing in this section requires a health benefit plan
126	126		to pay an enrollee's claim for a hearing aid in an amount that is
127	127		more than the benefit available under the health benefit plan.
128	128		SECTION 4. This Act applies only to a health benefit plan
129	129		that is delivered, issued for delivery, or renewed on or after
130	130		January 1, 2020.
131	131		SECTION 5. This Act takes effect September 1, 2019.