Texas 2023 - 88th Regular

Texas House Bill HB1322 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	88R21068 CJD-F
2	2	By: Buckley, et al. H.B. No. 1322
3	3	Substitute the following for H.B. No. 1322:
4	4	By: Oliverson C.S.H.B. No. 1322
5	5
6	6
7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to coordination of vision and eye care benefits under
10	10	certain health benefit plans and vision benefit plans.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Chapter 1203, Insurance Code, is amended by
13	13	adding Subchapter C to read as follows:
14	14	SUBCHAPTER C. VISION AND EYE CARE BENEFITS
15	15	Sec. 1203.101. DEFINITIONS. In this subchapter:
16	16	(1) "Eye care expenses" means expenses related to
17	17	vision or medical eye care services, procedures, or products.
18	18	(2) "Health benefit plan" means a policy, agreement,
19	19	contract, or evidence of coverage that provides comprehensive
20	20	medical coverage.
21	21	(3) "Vision benefit plan" means a limited-scope
22	22	policy, agreement, contract, or evidence of coverage that provides
23	23	coverage for eye care expenses but does not provide comprehensive
24	24	medical coverage.
25	25	Sec. 1203.102. APPLICABILITY OF SUBCHAPTER. This
26	26	subchapter applies only to a health benefit plan or vision benefit
27	27	plan that provides or arranges for benefits for vision or medical
28	28	eye care services, procedures, or products, including an
29	29	individual, group, blanket, or franchise insurance policy or
30	30	insurance agreement, a group hospital service contract, an evidence
31	31	of coverage, or a vision benefit plan offered by:
32	32	(1) an insurance company;
33	33	(2) a group hospital service corporation operating
34	34	under Chapter 842;
35	35	(3) a health maintenance organization operating under
36	36	Chapter 843;
37	37	(4) a stipulated premium company operating under
38	38	Chapter 884;
39	39	(5) a fraternal benefit society operating under
40	40	Chapter 885;
41	41	(6) a Lloyd's plan operating under Chapter 941;
42	42	(7) an exchange operating under Chapter 942; or
43	43	(8) a person or entity that provides a vision benefit
44	44	plan.
45	45	Sec. 1203.103. EXCEPTION. This subchapter does not apply
46	46	to a supplemental insurance policy that only pays benefits directly
47	47	to the policyholder.
48	48	Sec. 1203.104. COORDINATION OF BENEFITS BETWEEN PRIMARY AND
49	49	SECONDARY PLAN ISSUERS. (a) This section applies if:
50	50	(1) an enrollee is covered by at least two different
51	51	health benefit plans or vision benefit plans; and
52	52	(2) each plan provides the enrollee coverage for the
53	53	same vision or medical eye care services, procedures, or products.
54	54	(b) The issuer of the primary health benefit plan or vision
55	55	benefit plan, as determined under a coordination of benefits
56	56	provision applicable to the plan, is responsible for eye care
57	57	expenses covered under the plan up to the full amount of any plan
58	58	coverage limit applicable to the covered eye care expenses.
59	59	(c) Before the plan coverage limit described by Subsection
60	60	(b) is reached, the issuer of a secondary health benefit plan or
61	61	vision benefit plan, as determined under a coordination of benefits
62	62	provision applicable to the plan, is responsible only for eye care
63	63	expenses covered under the plan that are not covered under the
64	64	health benefit plan or vision benefit plan issued by the primary
65	65	plan issuer.
66	66	(d) After the plan coverage limit described by Subsection
67	67	(b) has been reached, the secondary plan issuer, in addition to the
68	68	responsibilities described by Subsection (c), is responsible for
69	69	any eye care expenses covered by both plans that exceed the plan
70	70	coverage limit described by Subsection (b) up to the coverage limit
71	71	of the secondary plan.
72	72	(e) When an enrollee is covered by more than one health
73	73	benefit plan or vision benefit plan that provides benefits for eye
74	74	care expenses, the enrollee may use each plan on the same date of
75	75	service up to the coverage limit of each plan.
76	76	(f) A vision benefit plan issuer shall coordinate benefits
77	77	with a health benefit plan issuer if both provide benefits for eye
78	78	care expenses.
79	79	(g) A vision benefit plan issuer may not require a claim
80	80	denial before adjudicating a claim up to the coverage limit of the
81	81	plan.
82	82	(h) Nothing in this section prevents a secondary plan issuer
83	83	from requiring proof that a related claim has been submitted to a
84	84	primary plan issuer for purposes of determining the remaining
85	85	balance up to the secondary plan's coverage limits.
86	86	(i) If a secondary plan issuer requires proof that a related
87	87	claim has been submitted to a primary plan issuer as described by
88	88	Subsection (h), the mechanism of providing proof must be through an
89	89	online submission.
90	90	Sec. 1203.105. CERTAIN COORDINATION OF BENEFITS PROVISIONS
91	91	PROHIBITED. (a) A health benefit plan or vision benefit plan
92	92	subject to this subchapter may not be delivered, issued for
93	93	delivery, or renewed in this state if:
94	94	(1) a provision of the plan excludes or reduces the
95	95	payment of benefits for eye care expenses to or on behalf of an
96	96	enrollee;
97	97	(2) the reason for the exclusion or reduction is that
98	98	eye care benefits are payable or have been paid to or on behalf of
99	99	the enrollee under another plan; and
100	100	(3) the exclusion or reduction would apply before the
101	101	full amount of the eye care expenses incurred by the enrollee and
102	102	covered by both plans have been paid or reimbursed or the full
103	103	amount of the applicable coverage limit of the plan containing the
104	104	exclusion or reduction is reached.
105	105	(b) Nothing in this section requires a secondary plan issuer
106	106	to pay an amount that, when added to a payment amount made by a
107	107	primary plan issuer, would exceed the usual and customary billed
108	108	charges of the health care provider.
109	109	Sec. 1203.106. CERTAIN COORDINATION OF BENEFITS PROVISIONS
110	110	VOID. A provision of a health benefit plan or vision benefit plan
111	111	that violates this subchapter is void.
112	112	Sec. 1203.107. RULES. The commissioner may adopt rules
113	113	necessary to implement this subchapter.
114	114	SECTION 2. The change in law made by this Act applies only
115	115	to a health benefit plan or vision benefit plan that is delivered,
116	116	issued for delivery, or renewed on or after January 1, 2024. A plan
117	117	delivered, issued for delivery, or renewed before January 1, 2024,
118	118	is governed by the law as it existed immediately before the
119	119	effective date of this Act, and that law is continued in effect for
120	120	that purpose.
121	121	SECTION 3. This Act takes effect September 1, 2023.