| 4 | 6 | | AN ACT |
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| 5 | 7 | | relating to the applicability of certain provisions mandating the |
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| 6 | 8 | | provision by certain health benefit plans of health benefits |
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| 7 | 9 | | requiring cost defrayal by this state. |
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| 8 | 10 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 9 | 11 | | SECTION 1. Chapter 1425, Insurance Code, is amended by |
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| 10 | 12 | | adding Subchapter A, and a heading is added to that subchapter to |
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| 11 | 13 | | read as follows: |
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| 12 | 14 | | SUBCHAPTER A. EXCEPTED BENEFITS |
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| 13 | 15 | | SECTION 2. Sections 1425.001 and 1425.002, Insurance Code, |
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| 14 | 16 | | are transferred to Subchapter A, Chapter 1425, Insurance Code, as |
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| 15 | 17 | | added by this Act. |
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| 16 | 18 | | SECTION 3. Chapter 1425, Insurance Code, is amended by |
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| 17 | 19 | | adding Subchapter B to read as follows: |
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| 18 | 20 | | SUBCHAPTER B. BENEFITS REQUIRING DEFRAYAL |
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| 19 | 21 | | Sec. 1425.051. DEFINITION. In this subchapter, "qualified |
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| 20 | 22 | | health plan" has the meaning assigned by 45 C.F.R. Section 155.20. |
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| 21 | 23 | | Sec. 1425.052. EXEMPTION FROM SUBTITLE FOR BENEFITS |
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| 22 | 24 | | REQUIRING DEFRAYAL. (a) A provision of this subtitle that is |
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| 23 | 25 | | enacted on or after January 1, 2012, does not apply to a qualified |
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| 24 | 26 | | health plan if a determination is made under 45 C.F.R. Section |
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| 25 | 27 | | 155.170 that: |
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| 26 | 28 | | (1) the provision requires the qualified health plan |
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| 27 | 29 | | to offer benefits in addition to the essential health benefits |
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| 28 | 30 | | required under 42 U.S.C. Section 18022(b); and |
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| 29 | 31 | | (2) this state must make payments to defray the cost of |
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| 30 | 32 | | the additional benefits mandated by the provision. |
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| 31 | 33 | | (b) If a determination described by Subsection (a) is made |
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| 32 | 34 | | as to a qualified health plan, the provision to which the |
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| 33 | 35 | | determination relates does not apply to a non-qualified health plan |
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| 34 | 36 | | if the non-qualified health plan is offered in the same market as |
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| 35 | 37 | | the qualified health plan. |
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| 36 | 38 | | SECTION 4. This Act takes effect immediately if it receives |
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| 37 | 39 | | a vote of two-thirds of all the members elected to each house, as |
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| 38 | 40 | | provided by Section 39, Article III, Texas Constitution. If this |
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| 39 | 41 | | Act does not receive the vote necessary for immediate effect, this |
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| 40 | 42 | | Act takes effect September 1, 2021. |
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| 41 | | - | ______________________________ ______________________________ |
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| 42 | | - | President of the Senate Speaker of the House |
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| 43 | | - | I hereby certify that S.B. No. 2016 passed the Senate on |
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| 44 | | - | April 19, 2021, by the following vote: Yeas 31, Nays 0. |
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| 45 | | - | ______________________________ |
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| 46 | | - | Secretary of the Senate |
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| 47 | | - | I hereby certify that S.B. No. 2016 passed the House on |
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| 48 | | - | May 26, 2021, by the following vote: Yeas 138, Nays 9, two present |
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| 49 | | - | not voting. |
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| 50 | | - | ______________________________ |
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| 51 | | - | Chief Clerk of the House |
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| 52 | | - | Approved: |
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| 53 | | - | ______________________________ |
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| 54 | | - | Date |
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| 55 | | - | ______________________________ |
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| 56 | | - | Governor |
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