Texas 2019 - 86th Regular

Texas House Bill HB4442 Compare Versions

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

Old	New	Differences
1	1	86R13547 PMO-D
2	2	By: Lucio III H.B. No. 4442
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit coverage for general anesthesia in
8	8	connection with certain pediatric dental services.
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 G to read as follows:
12	12	SUBCHAPTER G. PEDIATRIC DENTISTRY
13	13	Sec. 1367.3001. APPLICABILITY OF SUBCHAPTER. (a) This
14	14	subchapter applies only to a health benefit plan that provides
15	15	benefits for medical, surgical, or dental expenses incurred as a
16	16	result of a health condition, accident, or sickness, including an
17	17	individual, group, blanket, or franchise insurance policy or
18	18	insurance agreement, a group hospital service contract, or an
19	19	individual or group evidence of coverage or similar coverage
20	20	document that is issued by:
21	21	(1) an insurance company;
22	22	(2) a group hospital service corporation operating
23	23	under Chapter 842;
24	24	(3) a health maintenance organization operating under
25	25	Chapter 843;
26	26	(4) an approved nonprofit health corporation that
27	27	holds a certificate of authority under Chapter 844;
28	28	(5) a multiple employer welfare arrangement that holds
29	29	a certificate of authority under Chapter 846;
30	30	(6) a stipulated premium company operating under
31	31	Chapter 884;
32	32	(7) a fraternal benefit society operating under
33	33	Chapter 885;
34	34	(8) a Lloyd's plan operating under Chapter 941; or
35	35	(9) an exchange operating under Chapter 942.
36	36	(b) Notwithstanding any other law, this subchapter applies
37	37	to:
38	38	(1) a small employer health benefit plan subject to
39	39	Chapter 1501, including coverage provided through a health group
40	40	cooperative under Subchapter B of that chapter;
41	41	(2) a standard health benefit plan issued under
42	42	Chapter 1507;
43	43	(3) a basic coverage plan under Chapter 1551;
44	44	(4) a basic plan under Chapter 1575;
45	45	(5) a primary care coverage plan under Chapter 1579;
46	46	(6) a plan providing basic coverage under Chapter
47	47	1601;
48	48	(7) health benefits provided by or through a church
49	49	benefits board under Subchapter I, Chapter 22, Business
50	50	Organizations Code;
51	51	(8) group health coverage made available by a school
52	52	district in accordance with Section 22.004, Education Code;
53	53	(9) the state Medicaid program, including the Medicaid
54	54	managed care program operated under Chapter 533, Government Code;
55	55	(10) the child health plan program under Chapter 62,
56	56	Health and Safety Code;
57	57	(11) a regional or local health care program operated
58	58	under Section 75.104, Health and Safety Code;
59	59	(12) a self-funded health benefit plan sponsored by a
60	60	professional employer organization under Chapter 91, Labor Code;
61	61	(13) county employee group health benefits provided
62	62	under Chapter 157, Local Government Code; and
63	63	(14) health and accident coverage provided by a risk
64	64	pool created under Chapter 172, Local Government Code.
65	65	(c) This subchapter applies to coverage under a group health
66	66	benefit plan provided to a resident of this state regardless of
67	67	whether the group policy, agreement, or contract is delivered,
68	68	issued for delivery, or renewed in this state.
69	69	Sec. 1367.3002. EXCEPTIONS. (a) This subchapter does not
70	70	apply to:
71	71	(1) a plan that provides coverage:
72	72	(A) for wages or payments in lieu of wages for a
73	73	period during which an employee is absent from work because of
74	74	sickness or injury;
75	75	(B) as a supplement to a liability insurance
76	76	policy;
77	77	(C) for credit insurance;
78	78	(D) only for vision care;
79	79	(E) only for hospital expenses; or
80	80	(F) only for indemnity for hospital confinement;
81	81	(2) a Medicare supplemental policy as defined by
82	82	Section 1882(g)(1), Social Security Act (42 U.S.C. Section
83	83	1395ss(g)(1));
84	84	(3) a workers' compensation insurance policy;
85	85	(4) medical payment insurance coverage provided under
86	86	a motor vehicle insurance policy; or
87	87	(5) a long-term care policy, including a nursing home
88	88	fixed indemnity policy, unless the commissioner determines that the
89	89	policy provides benefit coverage so comprehensive that the policy
90	90	is a health benefit plan as described by Section 1367.3001.
91	91	(b) This subchapter does not apply to an individual health
92	92	benefit plan issued on or before March 23, 2010, that has not had
93	93	any significant changes since that date that reduce benefits or
94	94	increase costs to the individual.
95	95	Sec. 1367.3003. COVERAGE FOR GENERAL ANESTHESIA. A health
96	96	benefit plan that provides coverage for dental services may not
97	97	exclude from coverage general anesthesia services in connection
98	98	with dental services provided to a covered individual who is:
99	99	(1) younger than 18 years of age; and
100	100	(2) unable to undergo the dental service in an office
101	101	setting or under local anesthesia due to a documented physical,
102	102	mental, or medical reason determined by the individual's physician
103	103	or by the dentist providing the dental care.
104	104	Sec. 1367.3004. CONDITIONAL EXCEPTION. This subchapter
105	105	does not apply to a qualified health plan if a determination is made
106	106	under 45 C.F.R. Section 155.170 that:
107	107	(1) this subchapter requires the plan to offer
108	108	benefits in addition to the essential health benefits required
109	109	under 42 U.S.C. Section 18022(b); and
110	110	(2) this state is required to defray the cost of the
111	111	benefits mandated under this subchapter.
112	112	SECTION 2. If before implementing any provision of this Act
113	113	a state agency determines that a waiver or authorization from a
114	114	federal agency is necessary for implementation of that provision,
115	115	the agency affected by the provision shall request the waiver or
116	116	authorization and may delay implementing that provision until the
117	117	waiver or authorization is granted.
118	118	SECTION 3. Subchapter G, Chapter 1367, Insurance Code, as
119	119	added by this Act, applies only to a health benefit plan that is
120	120	delivered, issued for delivery, or renewed on or after January 1,
121	121	2020.
122	122	SECTION 4. This Act takes effect September 1, 2019.