By: Johnson S.B. No. 2016
(Paul)
A BILL TO BE ENTITLED
AN ACT
relating to the applicability of certain provisions mandating the
provision by certain health benefit plans of health benefits
requiring cost defrayal by this state.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1425, Insurance Code, is amended by
adding Subchapter A, and a heading is added to that subchapter to
read as follows:
SUBCHAPTER A. EXCEPTED BENEFITS
SECTION 2. Sections 1425.001 and 1425.002, Insurance Code,
are transferred to Subchapter A, Chapter 1425, Insurance Code, as
added by this Act.
SECTION 3. Chapter 1425, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. BENEFITS REQUIRING DEFRAYAL
Sec. 1425.051. DEFINITION. In this subchapter, "qualified
health plan" has the meaning assigned by 45 C.F.R. Section 155.20.
Sec. 1425.052. EXEMPTION FROM SUBTITLE FOR BENEFITS
REQUIRING DEFRAYAL. (a) A provision of this subtitle that is
enacted on or after January 1, 2012, does not apply to a qualified
health plan if a determination is made under 45 C.F.R. Section
155.170 that:
(1) the provision requires the qualified health plan
to offer benefits in addition to the essential health benefits
required under 42 U.S.C. Section 18022(b); and
(2) this state must make payments to defray the cost of
the additional benefits mandated by the provision.
(b) If a determination described by Subsection (a) is made
as to a qualified health plan, the provision to which the
determination relates does not apply to a non-qualified health plan
if the non-qualified health plan is offered in the same market as
the qualified health plan.
SECTION 4. This Act takes effect immediately if it receives
a vote of two-thirds of all the members elected to each house, as
provided by Section 39, Article III, Texas Constitution. If this
Act does not receive the vote necessary for immediate effect, this
Act takes effect September 1, 2021.