Texas 2021 - 87th Regular

Texas House Bill HB3951 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1		87R21565 MWC-D
2	2		By: Cortez H.B. No. 3951
	3	+	Substitute the following for H.B. No. 3951:
	4	+	By: Oliverson C.S.H.B. No. 3951
3	5
4	6
5	7		A BILL TO BE ENTITLED
6	8		AN ACT
7	9		relating to health benefit plan coverage for certain tests to
8	10		detect prostate cancer.
9	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	12		SECTION 1. Section 1362.001, Insurance Code, is amended to
11	13		read as follows:
12	14		Sec. 1362.001. APPLICABILITY OF CHAPTER. (a) This chapter
13	15		applies only to a health benefit plan that[:
14	16		[(1)] provides benefits for medical or surgical
15	17		expenses incurred as a result of a health condition, accident, or
16	18		sickness, including[:
17	19		[(A)] an individual, group, blanket, or
18	20		franchise insurance policy or insurance agreement, a group hospital
19	21		service contract, or an individual or group evidence of coverage
20	22		that is offered by:
21	23		(1) [(i)] an insurance company;
22	24		(2) [(ii)] a group hospital service corporation
23	25		operating under Chapter 842;
24	26		(3) [(iii)] a fraternal benefit society operating
25	27		under Chapter 885;
26	28		(4) [(iv)] a stipulated premium company operating
27	29		under Chapter 884; [or]
28	30		(5) [(v)] a health maintenance organization operating
29	31		under Chapter 843; [and]
30	32		(6) an approved nonprofit health corporation that
31	33		holds a certificate of authority under Chapter 844;
32	34		(7) a multiple employer welfare arrangement that holds
33	35		a certificate of authority under Chapter 846;
34	36		(8) a Lloyd's plan operating under Chapter 941; or
35	37		(9) an exchange operating under Chapter 942.
36	38		(b) Notwithstanding any other law, this chapter applies to
37	39		[(B) to the extent permitted by the Employee Retirement Income
38	40		Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health
39	41		benefit plan that is offered by:
40	42		[(i) a multiple employer welfare
41	43		arrangement as defined by Section 3 of that Act; or
42	44		[(ii) another analogous benefit
43	45		arrangement;
44	46		[(2) is offered by]:
45	47		(1) a small employer health benefit plan subject to
46	48		Chapter 1501, including coverage provided through a health group
47	49		cooperative under Subchapter B of that chapter;
48	50		(2) a standard health benefit plan issued under
49	51		Chapter 1507;
50	52		(3) a basic coverage plan under Chapter 1551;
51	53		(4) a basic plan under Chapter 1575;
52	54		(5) a primary care coverage plan under Chapter 1579;
53	55		(6) a plan providing basic coverage under Chapter
54	56		1601;
55	57		(7) health benefits provided by or through a church
56	58		benefits board under Subchapter I, Chapter 22, Business
57	59		Organizations Code;
58	60		(8) group health coverage made available by a school
59	61		district in accordance with Section 22.004, Education Code;
60	62		(9) the state Medicaid program, including the Medicaid
61	63		managed care program operated under Chapter 533, Government Code;
62	64		(10) the child health plan program under Chapter 62,
63	65		Health and Safety Code;
64	66		(11) a regional or local health care program operated
65	67		under Section 75.104, Health and Safety Code;
66	68		(12) a self-funded health benefit plan sponsored by a
67	69		professional employer organization under Chapter 91, Labor Code;
68	70		(13) a health benefit plan offered by [(A) an approved
69	71		nonprofit health corporation that holds a certificate of authority
70	72		under Chapter 844; or
71	73		[(B)] an entity not authorized under this code or
72	74		another insurance law of this state that contracts directly for
73	75		health care services on a risk-sharing basis, including a
74	76		capitation basis; and [or]
75	77		(14) [(3) provides] health and accident coverage
76	78		provided through a risk pool created under Chapter 172, Local
77	79		Government Code[, notwithstanding Section 172.014, Local
78	80		Government Code, or any other law].
79	81		SECTION 2. Section 1362.002, Insurance Code, is amended to
80	82		read as follows:
81	83		Sec. 1362.002. EXCEPTION. This chapter does not apply to:
82	84		(1) a health benefit plan that provides coverage:
83	85		(A) only for a specified disease or for another
84	86		limited benefit;
85	87		(B) only for accidental death or dismemberment;
86	88		(C) for wages or payments in lieu of wages for a
87	89		period during which an employee is absent from work because of
88	90		sickness or injury;
89	91		(D) as a supplement to a liability insurance
90	92		policy; or
91	93		(E) only for indemnity for hospital confinement;
92	94		(2) [a small employer health benefit plan written
93	95		under Chapter 1501;
94	96		[(3)] a Medicare supplemental policy as defined by
95	97		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
96	98		(3) [(4)] a workers' compensation insurance policy;
97	99		(4) [(5)] medical payment insurance coverage provided
98	100		under a motor vehicle insurance policy; or
99	101		(5) [(6)] a long-term care insurance policy,
100	102		including a nursing home fixed indemnity policy, unless the
101	103		commissioner determines that the policy provides benefit coverage
102	104		so comprehensive that the policy is a health benefit plan as
103	105		described by Section 1362.001.
104	106		SECTION 3. Section 1362.003, Insurance Code, is amended by
105	107		adding Subsections (c), (d), and (e) to read as follows:
106	108		(c) A health benefit plan that provides coverage under this
107	109		section may not charge any premium, copayment, coinsurance,
108	110		deductible, or any other form of cost sharing for a covered benefit
109	111		described by this section.
110	112		(d) Subsection (c) does not apply to a qualified health plan
111	113		if a determination is made under 45 C.F.R. Section 155.170 that:
112	114		(1) that subsection requires the plan to offer
113	115		benefits in addition to the essential health benefits required
114	116		under 42 U.S.C. Section 18022(b); and
115	117		(2) this state is required to defray the cost of the
116	118		benefits mandated under that subsection.
117	119		(e) If a determination described by Subsection (d) is made
118	120		as to a qualified health plan, Subsection (c) does not apply to a
119	121		non-qualified health plan if the non-qualified health plan is
120	122		offered in the same market as the qualified health plan.
121	123		SECTION 4. Section 1575.159, Insurance Code, is repealed.
122	124		SECTION 5. If before implementing any provision of this Act
123	125		a state agency determines that a waiver or authorization from a
124	126		federal agency is necessary for implementation of that provision,
125	127		the agency affected by the provision shall request the waiver or
126	128		authorization and may delay implementing that provision until the
127	129		waiver or authorization is granted.
128	130		SECTION 6. The changes in law made by this Act apply only to
129	131		a health benefit plan delivered, issued for delivery, or renewed on
130	132		or after January 1, 2022. A health benefit plan delivered, issued
131	133		for delivery, or renewed before January 1, 2022, is governed by the
132	134		law as it existed immediately before the effective date of this Act,
133	135		and that law is continued in effect for that purpose.
134	136		SECTION 7. This Act takes effect September 1, 2021.