86R4681 PMO-D
By: J. Johnson of Dallas, Lucio III, H.B. No. 2658
González of Dallas, Guillen
A BILL TO BE ENTITLED
AN ACT
relating to health benefit coverage for hearing aids for children
and adults.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 1365.001 through 1365.004, Insurance
Code, are designated as Subchapter A, Chapter 1365, Insurance Code,
and a heading is added to Subchapter A to read as follows:
SUBCHAPTER A. GENERAL PROVISIONS
SECTION 2. Sections 1365.001 and 1365.002, Insurance Code,
are amended to read as follows:
Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
subchapter [chapter] applies only to a group health benefit plan
that provides hospital and medical coverage on an expense-incurred,
service, or prepaid basis, including a group policy, contract, or
plan that is offered in this state by:
(1) an insurer;
(2) a group hospital service corporation operating
under Chapter 842; or
(3) a health maintenance organization operating under
Chapter 843.
Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
LAW. The provisions of Chapter 1201, including provisions relating
to the applicability, purpose, and enforcement of that chapter,
construction of policies under that chapter, rulemaking under that
chapter, and definitions of terms applicable in that chapter, apply
to this subchapter [chapter].
SECTION 3. Chapter 1365, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. HEARING AID COVERAGE
Sec. 1365.051. APPLICABILITY. (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 a self-funded health benefit
plan sponsored by a professional employer organization under
Chapter 91, Labor Code.
(d) 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.
(e) 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.
(f) Notwithstanding any other law, a standard health
benefit plan provided under Chapter 1507 must provide the coverage
required by this subchapter.
(g) 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.
Sec. 1365.052. EXCEPTION. (a) 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.
(b) This subchapter 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.
Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit
plan that provides coverage for hearing aids may not deny an
enrollee's claim for a hearing aid solely on the basis that the
price of the hearing aid is more than the benefit available under
the health benefit plan.
(b) Notwithstanding Section 1367.253(d), this section
applies to a health benefit plan subject to Subchapter F, Chapter
1367.
(c) Nothing in this section requires a health benefit plan
to pay an enrollee's claim for a hearing aid in an amount that is
more than the benefit available under the health benefit plan.
SECTION 4. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2020.
SECTION 5. This Act takes effect September 1, 2019.