Texas 2021 - 87th Regular

Texas Senate Bill SB827 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 827
	1	+	87R21898 SMT-F
	2	+	By: Kolkhorst, et al. S.B. No. 827
	3	+	(Lucio III, et al.)
	4	+	Substitute the following for S.B. No. 827: No.
2	5
3	6
	7	+	A BILL TO BE ENTITLED
4	8		AN ACT
5	9		relating to health benefit plan cost-sharing requirements for
6	10		prescription insulin.
7	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	12		SECTION 1. Chapter 1358, Insurance Code, is amended by
9	13		adding Subchapter C to read as follows:
10	14		SUBCHAPTER C. COST-SHARING LIMIT
11	15		Sec. 1358.101. APPLICABILITY OF SUBCHAPTER. (a) This
12	16		subchapter applies only to a health benefit plan that provides
13	17		benefits for medical or surgical expenses incurred as a result of a
14	18		health condition, accident, or sickness, including an individual,
15	19		group, blanket, or franchise insurance policy or insurance
16	20		agreement, a group hospital service contract, or a small or large
17	21		employer group contract or similar coverage document that is
18	22		offered by:
19	23		(1) an insurance company;
20	24		(2) a group hospital service corporation operating
21	25		under Chapter 842;
22	26		(3) a fraternal benefit society operating under
23	27		Chapter 885;
24	28		(4) a stipulated premium company operating under
25	29		Chapter 884;
26	30		(5) a reciprocal exchange operating under Chapter 942;
27	31		(6) a health maintenance organization operating under
28	32		Chapter 843;
29	33		(7) a multiple employer welfare arrangement that holds
30	34		a certificate of authority under Chapter 846; or
31	35		(8) an approved nonprofit health corporation that
32	36		holds a certificate of authority under Chapter 844.
33	37		(b) This subchapter applies to group health coverage made
34	38		available by a school district in accordance with Section 22.004,
35	39		Education Code.
36	40		(c) Notwithstanding any provision in Chapter 1551, 1575,
37	41		1579, or 1601 or any other law, this subchapter applies to:
38	42		(1) a basic coverage plan under Chapter 1551;
39	43		(2) a basic plan under Chapter 1575;
40	44		(3) a primary care coverage plan under Chapter 1579;
41	45		and
42	46		(4) basic coverage under Chapter 1601.
43	47		(d) Notwithstanding any other law, this subchapter applies
44	48		to coverage under:
45	49		(1) the child health plan program under Chapter 62,
46	50		Health and Safety Code, or the health benefits plan for children
47	51		under Chapter 63, Health and Safety Code; and
48	52		(2) the medical assistance program under Chapter 32,
49	53		Human Resources Code.
50	54		Sec. 1358.102. EXCEPTION. This subchapter does not apply
51	55		to:
52	56		(1) a health benefit plan that provides coverage:
53	57		(A) only for a specified disease or for another
54	58		single benefit;
55	59		(B) only for accidental death or dismemberment;
56	60		(C) for wages or payments in lieu of wages for a
57	61		period during which an employee is absent from work because of
58	62		sickness or injury;
59	63		(D) as a supplement to a liability insurance
60	64		policy;
61	65		(E) for credit insurance;
62	66		(F) only for dental or vision care;
63	67		(G) only for hospital expenses; or
64	68		(H) only for indemnity for hospital confinement;
65	69		(2) a Medicare supplemental policy as defined by
66	70		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
67	71		(3) medical payment insurance coverage provided under
68	72		a motor vehicle insurance policy;
69	73		(4) a long-term care insurance policy, including a
70	74		nursing home fixed indemnity policy, unless the commissioner
71	75		determines that the policy provides benefit coverage so
72	76		comprehensive that the policy is a health benefit plan as described
73	77		by Section 1358.101;
74	78		(5) health and accident coverage provided by a risk
75	79		pool created under Chapter 172, Local Government Code; or
76	80		(6) a workers' compensation insurance policy.
77	81		Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In
78	82		this section, "insulin" means a prescription drug that contains
79	83		insulin and is used to treat diabetes. The term does not include an
80	84		insulin drug that is administered to a patient intravenously.
81	85		(b) A health benefit plan may not impose a cost-sharing
82	86		provision for insulin that is included in the health benefit plan's
83	87		formulary if the total amount the enrollee is required to pay
84	88		exceeds $25 per prescription for a 30-day supply, regardless of the
85	89		amount or type of insulin needed to fill the enrollee's
86	90		prescription.
87	91		Sec. 1358.104. FORMULARY REQUIREMENT. A health benefit
88	92		plan must include at least one insulin from each therapeutic class
89	93		in the plan's formulary.
90	94		SECTION 2. The changes in law made by this Act apply only to
91	95		a health benefit plan that is delivered, issued for delivery, or
92	96		renewed on or after January 1, 2022. A health benefit plan
93	97		delivered, issued for delivery, or renewed before January 1, 2022,
94	98		is governed by the law as it existed immediately before the
95	99		effective date of this Act, and that law is continued in effect for
96	100		that purpose.
97	101		SECTION 3. This Act takes effect September 1, 2021.
98		-	______________________________ ______________________________
99		-	President of the Senate Speaker of the House
100		-	I hereby certify that S.B. No. 827 passed the Senate on
101		-	March 25, 2021, by the following vote: Yeas 27, Nays 3; and that
102		-	the Senate concurred in House amendment on May 27, 2021, by the
103		-	following vote: Yeas 28, Nays 3.
104		-	______________________________
105		-	Secretary of the Senate
106		-	I hereby certify that S.B. No. 827 passed the House, with
107		-	amendment, on May 24, 2021, by the following vote: Yeas 140,
108		-	Nays 5, one present not voting.
109		-	______________________________
110		-	Chief Clerk of the House
111		-	Approved:
112		-	______________________________
113		-	Date
114		-	______________________________
115		-	Governor