Texas 2023 - 88th Regular

Texas House Bill HB109 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	H.B. No. 109
2	2
3	3
4	4	AN ACT
5	5	relating to health benefit coverage for hearing aids for children
6	6	and adults.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Chapter 1365, Insurance Code, is amended by
9	9	designating Sections 1365.001 through 1365.004 as Subchapter A and
10	10	adding a subchapter heading to read as follows:
11	11	SUBCHAPTER A. GENERAL PROVISIONS
12	12	SECTION 2. Sections 1365.001 and 1365.002, Insurance Code,
13	13	are amended to read as follows:
14	14	Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
15	15	subchapter [chapter] applies only to a group health benefit plan
16	16	that provides hospital and medical coverage on an expense-incurred,
17	17	service, or prepaid basis, including a group policy, contract, or
18	18	plan that is offered in this state by:
19	19	(1) an insurer;
20	20	(2) a group hospital service corporation operating
21	21	under Chapter 842; or
22	22	(3) a health maintenance organization operating under
23	23	Chapter 843.
24	24	Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
25	25	LAW. The provisions of Chapter 1201, including provisions relating
26	26	to the applicability, purpose, and enforcement of that chapter,
27	27	construction of policies under that chapter, rulemaking under that
28	28	chapter, and definitions of terms applicable in that chapter, apply
29	29	to this subchapter [chapter].
30	30	SECTION 3. Chapter 1365, Insurance Code, is amended by
31	31	adding Subchapter B to read as follows:
32	32	SUBCHAPTER B. HEARING AID COVERAGE
33	33	Sec. 1365.051. APPLICABILITY. (a) This subchapter applies
34	34	only to a health benefit plan that provides benefits for medical or
35	35	surgical expenses incurred as a result of a health condition,
36	36	accident, or sickness, including an individual, group, blanket, or
37	37	franchise insurance policy or insurance agreement, a group hospital
38	38	service contract, or an individual or group evidence of coverage or
39	39	similar coverage document that is offered by:
40	40	(1) an insurance company;
41	41	(2) a group hospital service corporation operating
42	42	under Chapter 842;
43	43	(3) a health maintenance organization operating under
44	44	Chapter 843;
45	45	(4) an approved nonprofit health corporation that
46	46	holds a certificate of authority under Chapter 844;
47	47	(5) a multiple employer welfare arrangement that holds
48	48	a certificate of authority under Chapter 846;
49	49	(6) a stipulated premium company operating under
50	50	Chapter 884;
51	51	(7) a fraternal benefit society operating under
52	52	Chapter 885;
53	53	(8) a Lloyd's plan operating under Chapter 941; or
54	54	(9) an exchange operating under Chapter 942.
55	55	(b) This subchapter applies to coverage under a group health
56	56	benefit plan described by Subsection (a) provided to a resident of
57	57	this state, regardless of whether the group policy, agreement, or
58	58	contract is delivered, issued for delivery, or renewed within or
59	59	outside this state.
60	60	(c) Notwithstanding any other law, this subchapter applies
61	61	to:
62	62	(1) a small employer health benefit plan subject to
63	63	Chapter 1501, including coverage provided through a health group
64	64	cooperative under Subchapter B of that chapter;
65	65	(2) a standard health benefit plan issued under
66	66	Chapter 1507;
67	67	(3) a basic coverage plan under Chapter 1551;
68	68	(4) a basic plan under Chapter 1575;
69	69	(5) a primary care coverage plan under Chapter 1579;
70	70	(6) a plan providing basic coverage under Chapter
71	71	1601;
72	72	(7) a regional or local health care program operated
73	73	under Section 75.104, Health and Safety Code; and
74	74	(8) a self-funded health benefit plan sponsored by a
75	75	professional employer organization under Chapter 91, Labor Code.
76	76	Sec. 1365.052. EXCEPTION. This subchapter does not apply
77	77	to:
78	78	(1) a plan that provides coverage:
79	79	(A) for wages or payments in lieu of wages for a
80	80	period during which an employee is absent from work because of
81	81	sickness or injury; or
82	82	(B) only for hospital expenses; or
83	83	(2) the state Medicaid program, including the Medicaid
84	84	managed care program operated under Chapter 533, Government Code.
85	85	Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit
86	86	plan that provides coverage for hearing aids may not deny an
87	87	enrollee's claim for a hearing aid solely on the basis that the
88	88	price of the hearing aid is more than the benefit available under
89	89	the health benefit plan.
90	90	(b) Notwithstanding Section 1367.253(d), this section
91	91	applies to a health benefit plan subject to Subchapter F, Chapter
92	92	1367.
93	93	(c) Nothing in this section requires a health benefit plan
94	94	to pay an enrollee's claim for a hearing aid in an amount that is
95	95	more than the benefit available under the health benefit plan.
96	96	SECTION 4. This Act applies only to a health benefit plan
97	97	that is delivered, issued for delivery, or renewed on or after
98	98	January 1, 2024.
99	99	SECTION 5. This Act takes effect September 1, 2023.
100	100	______________________________ ______________________________
101	101	President of the Senate Speaker of the House
102	102	I certify that H.B. No. 109 was passed by the House on April
103	103	20, 2023, by the following vote: Yeas 143, Nays 3, 2 present, not
104	104	voting.
105	105	______________________________
106	106	Chief Clerk of the House
107	107	I certify that H.B. No. 109 was passed by the Senate on April
108	108	27, 2023, by the following vote: Yeas 30, Nays 1.
109	109	______________________________
110	110	Secretary of the Senate
111	111	APPROVED: _____________________
112	112	Date
113	113	_____________________
114	114	Governor