88R2143 CJD-F
By: Capriglione H.B. No. 1001
A BILL TO BE ENTITLED
AN ACT
relating to the definition of state-mandated health benefits for
the purposes of consumer choice of benefits plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1507.003, Insurance Code, is amended to
read as follows:
Sec. 1507.003. STATE-MANDATED HEALTH BENEFITS. (a) For
purposes of this subchapter, "state-mandated health benefits"
means coverage or another feature required under this code or other
laws of this state to be provided in an individual, blanket, or
group policy for accident and health insurance or a contract for a
health-related condition that:
(1) includes coverage for specific health care
services or benefits;
(2) places limitations or restrictions on
deductibles, coinsurance, copayments, or any annual or lifetime
maximum benefit amounts; [or]
(3) includes a specific category of licensed health
care practitioner from whom an insured is entitled to receive care;
(4) requires standard provisions or rights that are
unrelated to a specific health illness, injury, or condition of an
insured; or
(5) requires the policy or contract to exceed federal
requirements.
(b) For purposes of this subchapter, "state-mandated health
benefits" does not include benefits that are mandated by federal
law or standard provisions or rights required under this code or
other laws of this state to be provided in an individual, blanket,
or group policy for accident and health insurance if those standard
provisions or rights are also required to be provided in a basic
coverage plan under Chapter 1551 [that are unrelated to a specific
health illness, injury, or condition of an insured, including
provisions related to:
[(1) continuation of coverage under:
[(A) Subchapters F and G, Chapter 1251;
[(B) Section 1201.059; and
[(C) Subchapter B, Chapter 1253;
[(2) termination of coverage under Sections 1202.051
and 1501.108;
[(3) preexisting conditions under Subchapter D,
Chapter 1201, and Sections 1501.102-1501.105;
[(4) coverage of children, including newborn or
adopted children, under:
[(A) Subchapter D, Chapter 1251;
[(B) Sections 1201.053, 1201.061,
1201.063-1201.065, and Subchapter A, Chapter 1367;
[(C) Chapter 1504;
[(D) Chapter 1503;
[(E) Section 1501.157;
[(F) Section 1501.158; and
[(G) Sections 1501.607-1501.609;
[(5) services of practitioners under:
[(A) Subchapters A, B, and C, Chapter 1451; or
[(B) Section 1301.052;
[(6) supplies and services associated with the
treatment of diabetes under Subchapter B, Chapter 1358;
[(7) coverage for serious mental illness under
Subchapter A, Chapter 1355;
[(8) coverage for childhood immunizations and hearing
screening as required by Subchapters B and C, Chapter 1367, other
than Section 1367.053(c) and Chapter 1353;
[(9) coverage for reconstructive surgery for certain
craniofacial abnormalities of children as required by Subchapter D,
Chapter 1367;
[(10) coverage for the dietary treatment of
phenylketonuria as required by Chapter 1359;
[(11) coverage for referral to a non-network physician
or provider when medically necessary covered services are not
available through network physicians or providers, as required by
Section 1271.055; and
[(12) coverage for cancer screenings under:
[(A) Chapter 1356;
[(B) Chapter 1362;
[(C) Chapter 1363; and
[(D) Chapter 1370].
SECTION 2. Section 1507.053, Insurance Code, is amended to
read as follows:
Sec. 1507.053. STATE-MANDATED HEALTH BENEFITS. (a) For
purposes of this subchapter, "state-mandated health benefits"
means coverage or another feature required under this code or other
laws of this state to be provided in an evidence of coverage that:
(1) includes coverage for specific health care
services or benefits;
(2) places limitations or restrictions on
deductibles, coinsurance, copayments, or any annual or lifetime
maximum benefit amounts, including limitations provided in Section
1271.151; [or]
(3) includes a specific category of licensed health
care practitioner from whom an enrollee is entitled to receive
care;
(4) requires standard provisions or rights that are
unrelated to a specific health illness, injury, or condition of an
enrollee; or
(5) requires the evidence of coverage to exceed
federal requirements.
(b) For purposes of this subchapter, "state-mandated health
benefits" does not include coverage that is mandated by federal law
or standard provisions or rights required under this code or other
laws of this state to be provided in an evidence of coverage if
those standard provisions or rights are also required to be
provided in a basic coverage plan under Chapter 1551 [that are
unrelated to a specific health illness, injury, or condition of an
enrollee, including provisions related to:
[(1) continuation of coverage under Subchapter G,
Chapter 1251;
[(2) termination of coverage under Sections 1202.051
and 1501.108;
[(3) preexisting conditions under Subchapter D,
Chapter 1201, and Sections 1501.102-1501.105;
[(4) coverage of children, including newborn or
adopted children, under:
[(A) Chapter 1504;
[(B) Chapter 1503;
[(C) Section 1501.157;
[(D) Section 1501.158; and
[(E) Sections 1501.607-1501.609;
[(5) services of providers under Section 843.304;
[(6) coverage for serious mental health illness under
Subchapter A, Chapter 1355; and
[(7) coverage for cancer screenings under:
[(A) Chapter 1356;
[(B) Chapter 1362;
[(C) Chapter 1363; and
[(D) Chapter 1370].
SECTION 3. The changes in law made by this Act apply only to
a standard health benefit plan delivered, issued for delivery, or
renewed under Chapter 1507, Insurance Code, on or after January 1,
2024. A standard health benefit plan delivered, issued for
delivery, or renewed under Chapter 1507, Insurance Code, before
January 1, 2024, is governed by the law as it existed immediately
before the effective date of this Act, and that law is continued in
effect for that purpose.
SECTION 4. This Act takes effect September 1, 2023.