86R8203 MEW-D
By: Watson S.B. No. 825
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage of preexisting conditions
and the guaranteed issue of certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. The heading to Chapter 1202, Insurance Code, is
amended to read as follows:
CHAPTER 1202. ISSUANCE, CANCELLATION, AND CONTINUATION OF POLICIES
IN GENERAL
SECTION 2. The heading to Section 1202.051, Insurance Code,
is amended to read as follows:
Sec. 1202.051. GUARANTEED ISSUE, RENEWABILITY, AND
CONTINUATION OF INDIVIDUAL HEALTH INSURANCE POLICIES.
SECTION 3. Section 1202.051, Insurance Code, is amended by
adding Subsection (a-1) to read as follows:
(a-1) An insurer shall issue the individual health
insurance policy chosen by the individual to each individual that
elects to be covered under the policy and agrees to satisfy the
other requirements of the policy.
SECTION 4. Section 1501.602(a), Insurance Code, is amended
to read as follows:
(a) A large employer health benefit plan issuer:
(1) shall issue the large employer health benefit plan
chosen by the large employer to each large employer that elects to
be covered under the plan and agrees to satisfy the other
requirements of the plan [may refuse to provide coverage to a large
employer in accordance with the issuer's underwriting standards and
criteria;
[(2) shall accept or reject the entire group of
individuals who meet the participation criteria and choose
coverage]; and
(2) [(3)] may exclude only those employees or
dependents who decline coverage.
SECTION 5. Subtitle G, Title 8, Insurance Code, is amended
by adding Chapter 1509 to read as follows:
CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS
Sec. 1509.001. DEFINITION. In this chapter, "preexisting
condition" means a condition present before the effective date of
an individual's coverage under a health benefit plan.
Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan 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 health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(8) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(9) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
(10) the child health plan program under Chapter 62,
Health and Safety Code;
(11) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(12) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(13) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(14) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
(c) This chapter applies to coverage under a group health
benefit plan provided to a resident of this state regardless of
whether the group policy, agreement, or contract is delivered,
issued for delivery, or renewed in this state.
Sec. 1509.003. EXCEPTIONS. (a) This chapter 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 workers' compensation insurance policy; or
(3) medical payment insurance coverage provided under
a motor vehicle insurance policy.
(b) This chapter does not apply to an individual health
benefit plan issued on or before March 23, 2010, that has not had
any significant changes since that date that reduce benefits or
increase costs to the individual.
Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS
PROHIBITED. Notwithstanding any other law, a health benefit plan
issuer may not:
(1) deny coverage to or refuse to enroll an individual
in a health benefit plan on the basis of a preexisting condition;
(2) limit or exclude coverage under the health benefit
plan for treatment of the individual's preexisting condition
otherwise covered under the plan; or
(3) charge the individual more for coverage than the
health benefit plan issuer charges an individual who does not have a
preexisting condition.
SECTION 6. Section 1501.605, Insurance Code, is repealed.
SECTION 7. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 8. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2020. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2020,
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 9. This Act takes effect September 1, 2019.