Texas 2019 - 86th Regular

Texas Senate Bill SB825 Compare Versions

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

Old	New	Differences
1	1	86R8203 MEW-D
2	2	By: Watson S.B. No. 825
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage of preexisting conditions
8	8	and the guaranteed issue of certain health benefit plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. The heading to Chapter 1202, Insurance Code, is
11	11	amended to read as follows:
12	12	CHAPTER 1202. ISSUANCE, CANCELLATION, AND CONTINUATION OF POLICIES
13	13	IN GENERAL
14	14	SECTION 2. The heading to Section 1202.051, Insurance Code,
15	15	is amended to read as follows:
16	16	Sec. 1202.051. GUARANTEED ISSUE, RENEWABILITY, AND
17	17	CONTINUATION OF INDIVIDUAL HEALTH INSURANCE POLICIES.
18	18	SECTION 3. Section 1202.051, Insurance Code, is amended by
19	19	adding Subsection (a-1) to read as follows:
20	20	(a-1) An insurer shall issue the individual health
21	21	insurance policy chosen by the individual to each individual that
22	22	elects to be covered under the policy and agrees to satisfy the
23	23	other requirements of the policy.
24	24	SECTION 4. Section 1501.602(a), Insurance Code, is amended
25	25	to read as follows:
26	26	(a) A large employer health benefit plan issuer:
27	27	(1) shall issue the large employer health benefit plan
28	28	chosen by the large employer to each large employer that elects to
29	29	be covered under the plan and agrees to satisfy the other
30	30	requirements of the plan [may refuse to provide coverage to a large
31	31	employer in accordance with the issuer's underwriting standards and
32	32	criteria;
33	33	[(2) shall accept or reject the entire group of
34	34	individuals who meet the participation criteria and choose
35	35	coverage]; and
36	36	(2) [(3)] may exclude only those employees or
37	37	dependents who decline coverage.
38	38	SECTION 5. Subtitle G, Title 8, Insurance Code, is amended
39	39	by adding Chapter 1509 to read as follows:
40	40	CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS
41	41	Sec. 1509.001. DEFINITION. In this chapter, "preexisting
42	42	condition" means a condition present before the effective date of
43	43	an individual's coverage under a health benefit plan.
44	44	Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter
45	45	applies only to a health benefit plan that provides benefits for
46	46	medical or surgical expenses incurred as a result of a health
47	47	condition, accident, or sickness, including an individual, group,
48	48	blanket, or franchise insurance policy or insurance agreement, a
49	49	group hospital service contract, or an individual or group evidence
50	50	of coverage or similar coverage document that is offered by:
51	51	(1) an insurance company;
52	52	(2) a group hospital service corporation operating
53	53	under Chapter 842;
54	54	(3) a health maintenance organization operating under
55	55	Chapter 843;
56	56	(4) an approved nonprofit health corporation that
57	57	holds a certificate of authority under Chapter 844;
58	58	(5) a multiple employer welfare arrangement that holds
59	59	a certificate of authority under Chapter 846;
60	60	(6) a stipulated premium company operating under
61	61	Chapter 884;
62	62	(7) a fraternal benefit society operating under
63	63	Chapter 885;
64	64	(8) a Lloyd's plan operating under Chapter 941; or
65	65	(9) an exchange operating under Chapter 942.
66	66	(b) Notwithstanding any other law, this chapter applies to:
67	67	(1) a small employer health benefit plan subject to
68	68	Chapter 1501, including coverage provided through a health group
69	69	cooperative under Subchapter B of that chapter;
70	70	(2) a standard health benefit plan issued under
71	71	Chapter 1507;
72	72	(3) a basic coverage plan under Chapter 1551;
73	73	(4) a basic plan under Chapter 1575;
74	74	(5) a primary care coverage plan under Chapter 1579;
75	75	(6) a plan providing basic coverage under Chapter
76	76	1601;
77	77	(7) health benefits provided by or through a church
78	78	benefits board under Subchapter I, Chapter 22, Business
79	79	Organizations Code;
80	80	(8) group health coverage made available by a school
81	81	district in accordance with Section 22.004, Education Code;
82	82	(9) the state Medicaid program, including the Medicaid
83	83	managed care program operated under Chapter 533, Government Code;
84	84	(10) the child health plan program under Chapter 62,
85	85	Health and Safety Code;
86	86	(11) a regional or local health care program operated
87	87	under Section 75.104, Health and Safety Code;
88	88	(12) a self-funded health benefit plan sponsored by a
89	89	professional employer organization under Chapter 91, Labor Code;
90	90	(13) county employee group health benefits provided
91	91	under Chapter 157, Local Government Code; and
92	92	(14) health and accident coverage provided by a risk
93	93	pool created under Chapter 172, Local Government Code.
94	94	(c) This chapter applies to coverage under a group health
95	95	benefit plan provided to a resident of this state regardless of
96	96	whether the group policy, agreement, or contract is delivered,
97	97	issued for delivery, or renewed in this state.
98	98	Sec. 1509.003. EXCEPTIONS. (a) This chapter does not apply
99	99	to:
100	100	(1) a plan that provides coverage:
101	101	(A) for wages or payments in lieu of wages for a
102	102	period during which an employee is absent from work because of
103	103	sickness or injury;
104	104	(B) as a supplement to a liability insurance
105	105	policy;
106	106	(C) for credit insurance;
107	107	(D) only for dental or vision care;
108	108	(E) only for hospital expenses; or
109	109	(F) only for indemnity for hospital confinement;
110	110	(2) a workers' compensation insurance policy; or
111	111	(3) medical payment insurance coverage provided under
112	112	a motor vehicle insurance policy.
113	113	(b) This chapter does not apply to an individual health
114	114	benefit plan issued on or before March 23, 2010, that has not had
115	115	any significant changes since that date that reduce benefits or
116	116	increase costs to the individual.
117	117	Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS
118	118	PROHIBITED. Notwithstanding any other law, a health benefit plan
119	119	issuer may not:
120	120	(1) deny coverage to or refuse to enroll an individual
121	121	in a health benefit plan on the basis of a preexisting condition;
122	122	(2) limit or exclude coverage under the health benefit
123	123	plan for treatment of the individual's preexisting condition
124	124	otherwise covered under the plan; or
125	125	(3) charge the individual more for coverage than the
126	126	health benefit plan issuer charges an individual who does not have a
127	127	preexisting condition.
128	128	SECTION 6. Section 1501.605, Insurance Code, is repealed.
129	129	SECTION 7. If before implementing any provision of this Act
130	130	a state agency determines that a waiver or authorization from a
131	131	federal agency is necessary for implementation of that provision,
132	132	the agency affected by the provision shall request the waiver or
133	133	authorization and may delay implementing that provision until the
134	134	waiver or authorization is granted.
135	135	SECTION 8. The change in law made by this Act applies only
136	136	to a health benefit plan that is delivered, issued for delivery, or
137	137	renewed on or after January 1, 2020. A health benefit plan that is
138	138	delivered, issued for delivery, or renewed before January 1, 2020,
139	139	is governed by the law as it existed immediately before the
140	140	effective date of this Act, and that law is continued in effect for
141	141	that purpose.
142	142	SECTION 9. This Act takes effect September 1, 2019.