Texas 2021 - 87th Regular

Texas Senate Bill SB76 Compare Versions

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

Old	New	Differences
1	1	87R464 SMT-D
2	2	By: Miles S.B. No. 76
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to a limit on cost-sharing requirements imposed by a
8	8	health benefit plan for certain prescription insulin.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1358, Insurance Code, is amended by
11	11	adding Subchapter C to read as follows:
12	12	SUBCHAPTER C. COST-SHARING LIMIT
13	13	Sec. 1358.101. APPLICABILITY OF SUBCHAPTER. (a) This
14	14	subchapter applies only to a health benefit plan that provides
15	15	benefits for medical or surgical expenses incurred as a result of a
16	16	health condition, accident, or sickness, including an individual,
17	17	group, blanket, or franchise insurance policy or insurance
18	18	agreement, a group hospital service contract, or a small or large
19	19	employer group contract or similar coverage document that is
20	20	offered by:
21	21	(1) an insurance company;
22	22	(2) a group hospital service corporation operating
23	23	under Chapter 842;
24	24	(3) a fraternal benefit society operating under
25	25	Chapter 885;
26	26	(4) a stipulated premium company operating under
27	27	Chapter 884;
28	28	(5) a reciprocal exchange operating under Chapter 942;
29	29	(6) a health maintenance organization operating under
30	30	Chapter 843;
31	31	(7) a multiple employer welfare arrangement that holds
32	32	a certificate of authority under Chapter 846; or
33	33	(8) an approved nonprofit health corporation that
34	34	holds a certificate of authority under Chapter 844.
35	35	(b) This subchapter applies to group health coverage made
36	36	available by a school district in accordance with Section 22.004,
37	37	Education Code.
38	38	(c) Notwithstanding any provision in Chapter 1551, 1575,
39	39	1579, or 1601 or any other law, this subchapter applies to:
40	40	(1) a basic coverage plan under Chapter 1551;
41	41	(2) a basic plan under Chapter 1575;
42	42	(3) a primary care coverage plan under Chapter 1579;
43	43	and
44	44	(4) basic coverage under Chapter 1601.
45	45	(d) Notwithstanding any other law, this subchapter applies
46	46	to coverage under:
47	47	(1) the child health plan program under Chapter 62,
48	48	Health and Safety Code, or the health benefits plan for children
49	49	under Chapter 63, Health and Safety Code; and
50	50	(2) the medical assistance program under Chapter 32,
51	51	Human Resources Code.
52	52	Sec. 1358.102. EXCEPTION. This subchapter does not apply
53	53	to:
54	54	(1) a health benefit plan that provides coverage:
55	55	(A) only for a specified disease or for another
56	56	single benefit;
57	57	(B) only for accidental death or dismemberment;
58	58	(C) for wages or payments in lieu of wages for a
59	59	period during which an employee is absent from work because of
60	60	sickness or injury;
61	61	(D) as a supplement to a liability insurance
62	62	policy;
63	63	(E) for credit insurance;
64	64	(F) only for dental or vision care;
65	65	(G) only for hospital expenses; or
66	66	(H) only for indemnity for hospital confinement;
67	67	(2) a Medicare supplemental policy as defined by
68	68	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
69	69	(3) medical payment insurance coverage provided under
70	70	a motor vehicle insurance policy;
71	71	(4) a long-term care insurance policy, including a
72	72	nursing home fixed indemnity policy, unless the commissioner
73	73	determines that the policy provides benefit coverage so
74	74	comprehensive that the policy is a health benefit plan as described
75	75	by Section 1358.101;
76	76	(5) health and accident coverage provided by a risk
77	77	pool created under Chapter 172, Local Government Code; or
78	78	(6) a workers' compensation insurance policy.
79	79	Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In
80	80	this section, "insulin" means a prescription drug that contains
81	81	insulin and is used to treat diabetes. The term does not include an
82	82	insulin drug that is administered to a patient intravenously.
83	83	(b) Subject to Subsection (c), a health benefit plan may not
84	84	impose a cost-sharing provision for insulin if the total amount the
85	85	enrollee is required to pay exceeds $100 for a 30-day supply.
86	86	(c) On January 1 of each year, the limit on the amount that
87	87	an enrollee may be required to pay for a 30-day supply of insulin
88	88	increases by a percentage equal to any percentage increase from the
89	89	preceding year in the medical care component of the Consumer Price
90	90	Index of the Bureau of Labor Statistics of the United States
91	91	Department of Labor.
92	92	(c-1) Subsection (c) takes effect January 1, 2023. This
93	93	subsection expires September 1, 2023.
94	94	SECTION 2. The changes in law made by this Act apply only to
95	95	a health benefit plan that is delivered, issued for delivery, or
96	96	renewed on or after January 1, 2022. A health benefit plan
97	97	delivered, issued for delivery, or renewed before January 1, 2022,
98	98	is governed by the law as it existed immediately before the
99	99	effective date of this Act, and that law is continued in effect for
100	100	that purpose.
101	101	SECTION 3. This Act takes effect September 1, 2021.