Texas 2023 - 88th Regular

Texas House Bill HB1001 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R2143 CJD-F
2	2	By: Capriglione H.B. No. 1001
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to the definition of state-mandated health benefits for
8	8	the purposes of consumer choice of benefits plans.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1507.003, Insurance Code, is amended to
11	11	read as follows:
12	12	Sec. 1507.003. STATE-MANDATED HEALTH BENEFITS. (a) For
13	13	purposes of this subchapter, "state-mandated health benefits"
14	14	means coverage or another feature required under this code or other
15	15	laws of this state to be provided in an individual, blanket, or
16	16	group policy for accident and health insurance or a contract for a
17	17	health-related condition that:
18	18	(1) includes coverage for specific health care
19	19	services or benefits;
20	20	(2) places limitations or restrictions on
21	21	deductibles, coinsurance, copayments, or any annual or lifetime
22	22	maximum benefit amounts; [or]
23	23	(3) includes a specific category of licensed health
24	24	care practitioner from whom an insured is entitled to receive care;
25	25	(4) requires standard provisions or rights that are
26	26	unrelated to a specific health illness, injury, or condition of an
27	27	insured; or
28	28	(5) requires the policy or contract to exceed federal
29	29	requirements.
30	30	(b) For purposes of this subchapter, "state-mandated health
31	31	benefits" does not include benefits that are mandated by federal
32	32	law or standard provisions or rights required under this code or
33	33	other laws of this state to be provided in an individual, blanket,
34	34	or group policy for accident and health insurance if those standard
35	35	provisions or rights are also required to be provided in a basic
36	36	coverage plan under Chapter 1551 [that are unrelated to a specific
37	37	health illness, injury, or condition of an insured, including
38	38	provisions related to:
39	39	[(1) continuation of coverage under:
40	40	[(A) Subchapters F and G, Chapter 1251;
41	41	[(B) Section 1201.059; and
42	42	[(C) Subchapter B, Chapter 1253;
43	43	[(2) termination of coverage under Sections 1202.051
44	44	and 1501.108;
45	45	[(3) preexisting conditions under Subchapter D,
46	46	Chapter 1201, and Sections 1501.102-1501.105;
47	47	[(4) coverage of children, including newborn or
48	48	adopted children, under:
49	49	[(A) Subchapter D, Chapter 1251;
50	50	[(B) Sections 1201.053, 1201.061,
51	51	1201.063-1201.065, and Subchapter A, Chapter 1367;
52	52	[(C) Chapter 1504;
53	53	[(D) Chapter 1503;
54	54	[(E) Section 1501.157;
55	55	[(F) Section 1501.158; and
56	56	[(G) Sections 1501.607-1501.609;
57	57	[(5) services of practitioners under:
58	58	[(A) Subchapters A, B, and C, Chapter 1451; or
59	59	[(B) Section 1301.052;
60	60	[(6) supplies and services associated with the
61	61	treatment of diabetes under Subchapter B, Chapter 1358;
62	62	[(7) coverage for serious mental illness under
63	63	Subchapter A, Chapter 1355;
64	64	[(8) coverage for childhood immunizations and hearing
65	65	screening as required by Subchapters B and C, Chapter 1367, other
66	66	than Section 1367.053(c) and Chapter 1353;
67	67	[(9) coverage for reconstructive surgery for certain
68	68	craniofacial abnormalities of children as required by Subchapter D,
69	69	Chapter 1367;
70	70	[(10) coverage for the dietary treatment of
71	71	phenylketonuria as required by Chapter 1359;
72	72	[(11) coverage for referral to a non-network physician
73	73	or provider when medically necessary covered services are not
74	74	available through network physicians or providers, as required by
75	75	Section 1271.055; and
76	76	[(12) coverage for cancer screenings under:
77	77	[(A) Chapter 1356;
78	78	[(B) Chapter 1362;
79	79	[(C) Chapter 1363; and
80	80	[(D) Chapter 1370].
81	81	SECTION 2. Section 1507.053, Insurance Code, is amended to
82	82	read as follows:
83	83	Sec. 1507.053. STATE-MANDATED HEALTH BENEFITS. (a) For
84	84	purposes of this subchapter, "state-mandated health benefits"
85	85	means coverage or another feature required under this code or other
86	86	laws of this state to be provided in an evidence of coverage that:
87	87	(1) includes coverage for specific health care
88	88	services or benefits;
89	89	(2) places limitations or restrictions on
90	90	deductibles, coinsurance, copayments, or any annual or lifetime
91	91	maximum benefit amounts, including limitations provided in Section
92	92	1271.151; [or]
93	93	(3) includes a specific category of licensed health
94	94	care practitioner from whom an enrollee is entitled to receive
95	95	care;
96	96	(4) requires standard provisions or rights that are
97	97	unrelated to a specific health illness, injury, or condition of an
98	98	enrollee; or
99	99	(5) requires the evidence of coverage to exceed
100	100	federal requirements.
101	101	(b) For purposes of this subchapter, "state-mandated health
102	102	benefits" does not include coverage that is mandated by federal law
103	103	or standard provisions or rights required under this code or other
104	104	laws of this state to be provided in an evidence of coverage if
105	105	those standard provisions or rights are also required to be
106	106	provided in a basic coverage plan under Chapter 1551 [that are
107	107	unrelated to a specific health illness, injury, or condition of an
108	108	enrollee, including provisions related to:
109	109	[(1) continuation of coverage under Subchapter G,
110	110	Chapter 1251;
111	111	[(2) termination of coverage under Sections 1202.051
112	112	and 1501.108;
113	113	[(3) preexisting conditions under Subchapter D,
114	114	Chapter 1201, and Sections 1501.102-1501.105;
115	115	[(4) coverage of children, including newborn or
116	116	adopted children, under:
117	117	[(A) Chapter 1504;
118	118	[(B) Chapter 1503;
119	119	[(C) Section 1501.157;
120	120	[(D) Section 1501.158; and
121	121	[(E) Sections 1501.607-1501.609;
122	122	[(5) services of providers under Section 843.304;
123	123	[(6) coverage for serious mental health illness under
124	124	Subchapter A, Chapter 1355; and
125	125	[(7) coverage for cancer screenings under:
126	126	[(A) Chapter 1356;
127	127	[(B) Chapter 1362;
128	128	[(C) Chapter 1363; and
129	129	[(D) Chapter 1370].
130	130	SECTION 3. The changes in law made by this Act apply only to
131	131	a standard health benefit plan delivered, issued for delivery, or
132	132	renewed under Chapter 1507, Insurance Code, on or after January 1,
133	133	2024. A standard health benefit plan delivered, issued for
134	134	delivery, or renewed under Chapter 1507, Insurance Code, before
135	135	January 1, 2024, is governed by the law as it existed immediately
136	136	before the effective date of this Act, and that law is continued in
137	137	effect for that purpose.
138	138	SECTION 4. This Act takes effect September 1, 2023.