88R12290 CJD-D
By: Talarico H.B. No. 3034
A BILL TO BE ENTITLED
AN ACT
relating to notice regarding nonemergency ambulance and certain
nonemergency health care coverage in health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1210, Insurance Code, is amended to read
as follows:
CHAPTER 1210. NOTICE OF CERTAIN POLICY PROVISIONS
SUBCHAPTER A. NOTICE OF PROVISIONS RELATED TO RENEWAL OR NONRENEWAL
Sec. 1210.001. NOTICE REQUIRED. A policy, contract, or
certificate of insurance that insures against loss resulting from
sickness or accidental bodily injury and that is subject to an
increase in the premium at time of renewal or to nonrenewal on the
insured attaining a certain age may not be delivered, issued, or
used in this state unless the document contains on the first page
above the policy provisions a printed notice in 10-point type that
states that the policy, contract, or certificate is subject to
either or both conditions.
SUBCHAPTER B. AMBULANCE AND CERTAIN NONEMERGENCY HEALTH CARE
COVERAGE PROVISIONS
Sec. 1210.011. DEFINITION. In this subchapter, "emergency
medical services personnel" has the meaning assigned by Section
773.003, Health and Safety Code.
Sec. 1210.012. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation
that holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) health benefits provided by or through a church
benefits board under Subchapter I, Chapter 22, Business
Organizations Code;
(10) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 533,
Government Code;
(11) the child health plan program under Chapter 62,
Health and Safety Code;
(12) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(13) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(14) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(15) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1210.013. NOTICE REQUIRED. (a) This section applies
only with respect to a health benefit plan that does not provide
coverage for nonemergency ambulance services or nonemergency
health care services provided by emergency medical services
personnel.
(b) A health benefit plan issuer or administrator shall
provide written notice in the form and manner prescribed by the
commissioner in an explanation of benefits provided to an enrollee
that the enrollee's plan does not cover nonemergency ambulance
services or nonemergency health care services provided by emergency
medical services personnel.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing the provision until the
waiver or authorization is granted.
SECTION 3. This Act takes effect September 1, 2023.