Texas 2021 - 87th Regular

Texas House Bill HB3043 Compare Versions

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

Old	New	Differences
1	1	87R9018 RDS-D
2	2	By: Thierry H.B. No. 3043
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage of individuals with a
8	8	prior diagnosis of COVID-19.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle G, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1511 to read as follows:
12	12	CHAPTER 1511. COVERAGE OF PREEXISTING CONDITIONS
13	13	Sec. 1511.001. DEFINITION. In this chapter, "prior
14	14	diagnosis of COVID-19" means a diagnosis of coronavirus disease
15	15	(COVID-19) or a related symptom or condition, present before the
16	16	effective date of an individual's coverage under a health benefit
17	17	plan.
18	18	Sec. 1511.002. APPLICABILITY OF CHAPTER. (a) This chapter
19	19	applies only to a health benefit plan that provides benefits for
20	20	medical or surgical expenses incurred as a result of a health
21	21	condition, accident, or sickness, including an individual, group,
22	22	blanket, or franchise insurance policy or insurance agreement, a
23	23	group hospital service contract, or an individual or group evidence
24	24	of coverage or similar coverage document that is offered by:
25	25	(1) an insurance company;
26	26	(2) a group hospital service corporation operating
27	27	under Chapter 842;
28	28	(3) a health maintenance organization operating under
29	29	Chapter 843;
30	30	(4) an approved nonprofit health corporation that
31	31	holds a certificate of authority under Chapter 844;
32	32	(5) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846;
34	34	(6) a stipulated premium company operating under
35	35	Chapter 884;
36	36	(7) a fraternal benefit society operating under
37	37	Chapter 885;
38	38	(8) a Lloyd's plan operating under Chapter 941; or
39	39	(9) an exchange operating under Chapter 942.
40	40	(b) Notwithstanding any other law, this chapter applies to:
41	41	(1) a small employer health benefit plan subject to
42	42	Chapter 1501, including coverage provided through a health group
43	43	cooperative under Subchapter B of that chapter;
44	44	(2) a standard health benefit plan issued under
45	45	Chapter 1507;
46	46	(3) a basic coverage plan under Chapter 1551;
47	47	(4) a basic plan under Chapter 1575;
48	48	(5) a primary care coverage plan under Chapter 1579;
49	49	(6) a plan providing basic coverage under Chapter
50	50	1601;
51	51	(7) health benefits provided by or through a church
52	52	benefits board under Subchapter I, Chapter 22, Business
53	53	Organizations Code;
54	54	(8) group health coverage made available by a school
55	55	district in accordance with Section 22.004, Education Code;
56	56	(9) the state Medicaid program, including the Medicaid
57	57	managed care program operated under Chapter 533, Government Code;
58	58	(10) the child health plan program under Chapter 62,
59	59	Health and Safety Code;
60	60	(11) a regional or local health care program operated
61	61	under Section 75.104, Health and Safety Code;
62	62	(12) a self-funded health benefit plan sponsored by a
63	63	professional employer organization under Chapter 91, Labor Code;
64	64	(13) county employee group health benefits provided
65	65	under Chapter 157, Local Government Code; and
66	66	(14) health and accident coverage provided by a risk
67	67	pool created under Chapter 172, Local Government Code.
68	68	(c) This chapter applies to coverage under a group health
69	69	benefit plan provided to a resident of this state regardless of
70	70	whether the group policy, agreement, or contract is delivered,
71	71	issued for delivery, or renewed in this state.
72	72	(d) Notwithstanding any other law, this chapter applies to a
73	73	health benefit plan under which coverage is contractually limited
74	74	to fewer than 12 months in duration.
75	75	Sec. 1511.003. EXCEPTIONS. This chapter does not apply to:
76	76	(1) a plan that provides coverage:
77	77	(A) only for a specified disease or for another
78	78	limited benefit;
79	79	(B) only for accidental death or dismemberment;
80	80	(C) for wages or payments in lieu of wages for a
81	81	period during which an employee is absent from work because of
82	82	sickness or injury;
83	83	(D) as a supplement to a liability insurance
84	84	policy;
85	85	(E) for credit insurance;
86	86	(F) only for dental or vision care; or
87	87	(G) only for indemnity for hospital confinement;
88	88	(2) a Medicare supplemental policy as defined by
89	89	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
90	90	(3) a workers' compensation insurance policy;
91	91	(4) medical payment insurance coverage provided under
92	92	a motor vehicle insurance policy; or
93	93	(5) a long-term care insurance policy, including a
94	94	nursing home fixed indemnity policy, unless the commissioner
95	95	determines that the policy provides benefit coverage so
96	96	comprehensive that the policy is a health benefit plan as described
97	97	by Section 1511.002.
98	98	Sec. 1511.004. RESTRICTIONS BASED ON PRIOR DIAGNOSIS OF
99	99	COVID-19 PROHIBITED. Notwithstanding any other law, a health
100	100	benefit plan issuer may not:
101	101	(1) deny coverage to or refuse to enroll an individual
102	102	in a health benefit plan on the basis of a prior diagnosis of
103	103	COVID-19;
104	104	(2) limit or exclude coverage under the health benefit
105	105	plan for treatment related to the individual's prior diagnosis of
106	106	COVID-19 otherwise covered under the plan; or
107	107	(3) charge the individual more for coverage than the
108	108	health benefit plan issuer charges an individual who does not have a
109	109	prior diagnosis of COVID-19.
110	110	SECTION 2. If before implementing any provision of this Act
111	111	a state agency determines that a waiver or authorization from a
112	112	federal agency is necessary for implementation of that provision,
113	113	the agency affected by the provision shall request the waiver or
114	114	authorization and may delay implementing that provision until the
115	115	waiver or authorization is granted.
116	116	SECTION 3. The change in law made by this Act applies only
117	117	to a health benefit plan that is delivered, issued for delivery, or
118	118	renewed on or after January 1, 2022. A health benefit plan that is
119	119	delivered, issued for delivery, or renewed before January 1, 2022,
120	120	is governed by the law as it existed immediately before the
121	121	effective date of this Act, and that law is continued in effect for
122	122	that purpose.
123	123	SECTION 4. This Act takes effect September 1, 2021.