88R14164 RDS-D
By: Morales Shaw H.B. No. 3912
A BILL TO BE ENTITLED
AN ACT
relating to the applicability of health benefit plan cost-sharing
requirements for prescription insulin.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Sections 1358.101(a) and (c), Insurance Code,
are amended to read as follows:
(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 a small
or large employer group contract or similar coverage document that
is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a health maintenance organization operating under
Chapter 843;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; [or]
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844; or
(9) a Lloyd's plan operating under Chapter 941.
(c) Notwithstanding any provision in Chapter 1551, 1575,
1579, or 1601 or 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) [(2)] a basic plan under Chapter 1575;
(5) [(3)] a primary care coverage plan under Chapter
1579; [and]
(6) [(4)] 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) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(11) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(12) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(13) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
SECTION 2. Section 1358.102, Insurance Code, is amended to
read as follows:
Sec. 1358.102. EXCEPTION. This subchapter does not apply
to:
(1) a health benefit plan that provides coverage:
(A) only for a specified disease or for another
single benefit;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy;
(E) for credit insurance;
(F) only for dental or vision care;
(G) only for hospital expenses; or
(H) only for indemnity for hospital confinement;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(3) medical payment insurance coverage provided under
a motor vehicle insurance policy;
(4) a long-term care insurance policy, including a
nursing home fixed indemnity policy, unless the commissioner
determines that the policy provides benefit coverage so
comprehensive that the policy is a health benefit plan as described
by Section 1358.101; or
(5) [health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code; or
[(6)] a workers' compensation insurance policy.
SECTION 3. The changes in law made by this Act apply only to
a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2024. A health benefit 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 4. This Act takes effect September 1, 2023.