88R2521 CJD-F
By: Buckley H.B. No. 1322
A BILL TO BE ENTITLED
AN ACT
relating to coordination of vision and eye care benefits under
certain insurance policies and vision plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1203, Insurance Code, is amended by
adding Subchapter C to read as follows:
SUBCHAPTER C. VISION AND EYE CARE BENEFITS
Sec. 1203.101. DEFINITIONS. In this subchapter:
(1) "Benefit plan" means an insurance policy, vision
benefit plan, or vision discount plan described by Section
1203.102.
(2) "Benefit plan provider" means an insurer or other
person or entity described by Section 1203.102 that issues or
provides a benefit plan.
(3) "Eye care expenses" means expenses related to
vision or medical eye care services, procedures, or products.
Sec. 1203.102. APPLICABILITY OF SUBCHAPTER. This
subchapter applies only to an insurance policy, vision benefit
plan, or vision discount plan that provides or arranges for
benefits for vision or medical eye care services, procedures, or
products, including an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, a vision benefit plan, or a vision discount plan offered
by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a stipulated premium company operating under
Chapter 884;
(4) a fraternal benefit society operating under
Chapter 885;
(5) a Lloyd's plan operating under Chapter 941;
(6) an exchange operating under Chapter 942; or
(7) a person or entity that provides a vision benefit
or vision discount plan.
Sec. 1203.103. COORDINATION OF BENEFITS BETWEEN MULTIPLE
PLANS. (a) This section applies if a benefit plan enrollee is
covered by at least two different benefit plans that provide
benefits for eye care expenses.
(b) The benefit plan provider to whom a claim for
reimbursement for eye care expenses is initially submitted shall
reimburse for all eye care expenses covered under the plan up to the
full amount of any coverage limit applicable to the covered eye care
expenses.
(c) A benefit plan provider to whom a claim for
reimbursement for eye care expenses is subsequently submitted shall
reimburse for all eye care expenses covered under the plan that are
not reimbursed by a benefit plan provider to whom a claim for
reimbursement was previously submitted.
(d) Each benefit plan provider shall provide a summary of
eye care expenses accepted and denied under the plan to the enrollee
and the practitioner who provided the eye care services. The
summary must be accessible online to the enrollee and the
practitioner.
Sec. 1203.104. CERTAIN COORDINATION OF BENEFITS PROVISIONS
PROHIBITED. A benefit plan may not be delivered, issued for
delivery, or renewed in this state if:
(1) a provision of the plan excludes or reduces the
payment of benefits for eye care expenses to or on behalf of an
enrollee;
(2) the reason for the exclusion or reduction is that
eye care benefits are payable or have been paid to or on behalf of
the enrollee under another benefit plan; and
(3) the exclusion or reduction would apply before the
full amount of the eye care expenses incurred by the enrollee and
covered by both plans have been paid or reimbursed or the full
amount of the applicable coverage limit of the plan containing the
exclusion or reduction is reached.
Sec. 1203.105. CERTAIN COORDINATION OF BENEFITS PROVISIONS
VOID. A provision of a benefit plan that violates this subchapter
is void.
SECTION 2. The change in law made by this Act applies only
to an insurance policy, vision benefit plan, or vision discount
plan that is delivered, issued for delivery, or renewed on or after
January 1, 2024. A policy or plan delivered, issued for delivery,
or renewed 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 3. This Act takes effect September 1, 2023.