Texas 2023 - 88th Regular

Texas Senate Bill SB51 Compare Versions

Version 1 (Old)

Version 2 (New)

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1	1	By: Zaffirini, Hinojosa, Miles S.B. No. 51
2	2	(In the Senate - Filed November 14, 2022; February 15, 2023,
3	3	read first time and referred to Committee on Health & Human
4	4	Services; April 18, 2023, reported adversely, with favorable
5	5	Committee Substitute by the following vote: Yeas 9, Nays 0;
6	6	April 18, 2023, sent to printer.)
7	7	Click here to see the committee vote
8	8	COMMITTEE SUBSTITUTE FOR S.B. No. 51 By: Hughes
9	9
10	10
11	11	A BILL TO BE ENTITLED
12	12	AN ACT
13	13	relating to health benefit coverage for hearing aids for children
14	14	and adults.
15	15	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
16	16	SECTION 1. Chapter 1365, Insurance Code, is amended by
17	17	designating Sections 1365.001 through 1365.004 as Subchapter A and
18	18	adding a subchapter heading to read as follows:
19	19	SUBCHAPTER A. GENERAL PROVISIONS
20	20	SECTION 2. Sections 1365.001 and 1365.002, Insurance Code,
21	21	are amended to read as follows:
22	22	Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
23	23	subchapter [chapter] applies only to a group health benefit plan
24	24	that provides hospital and medical coverage on an expense-incurred,
25	25	service, or prepaid basis, including a group policy, contract, or
26	26	plan that is offered in this state by:
27	27	(1) an insurer;
28	28	(2) a group hospital service corporation operating
29	29	under Chapter 842; or
30	30	(3) a health maintenance organization operating under
31	31	Chapter 843.
32	32	Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
33	33	LAW. The provisions of Chapter 1201, including provisions relating
34	34	to the applicability, purpose, and enforcement of that chapter,
35	35	construction of policies under that chapter, rulemaking under that
36	36	chapter, and definitions of terms applicable in that chapter, apply
37	37	to this subchapter [chapter].
38	38	SECTION 3. Chapter 1365, Insurance Code, is amended by
39	39	adding Subchapter B to read as follows:
40	40	SUBCHAPTER B. HEARING AID COVERAGE
41	41	Sec. 1365.051. APPLICABILITY. (a) This subchapter applies
42	42	only to a health benefit plan that provides benefits for medical or
43	43	surgical expenses incurred as a result of a health condition,
44	44	accident, or sickness, including an individual, group, blanket, or
45	45	franchise insurance policy or insurance agreement, a group hospital
46	46	service contract, or an individual or group evidence of coverage or
47	47	similar coverage document that is offered by:
48	48	(1) an insurance company;
49	49	(2) a group hospital service corporation operating
50	50	under Chapter 842;
51	51	(3) a health maintenance organization operating under
52	52	Chapter 843;
53	53	(4) an approved nonprofit health corporation that
54	54	holds a certificate of authority under Chapter 844;
55	55	(5) a multiple employer welfare arrangement that holds
56	56	a certificate of authority under Chapter 846;
57	57	(6) a stipulated premium company operating under
58	58	Chapter 884;
59	59	(7) a fraternal benefit society operating under
60	60	Chapter 885;
61	61	(8) a Lloyd's plan operating under Chapter 941; or
62	62	(9) an exchange operating under Chapter 942.
63	63	(b) This subchapter applies to coverage under a group health
64	64	benefit plan described by Subsection (a) provided to a resident of
65	65	this state, regardless of whether the group policy, agreement, or
66	66	contract is delivered, issued for delivery, or renewed within or
67	67	outside this state.
68	68	(c) Notwithstanding any other law, this subchapter applies
69	69	to:
70	70	(1) a small employer health benefit plan subject to
71	71	Chapter 1501, including coverage provided through a health group
72	72	cooperative under Subchapter B of that chapter;
73	73	(2) a standard health benefit plan issued under
74	74	Chapter 1507;
75	75	(3) a basic coverage plan under Chapter 1551;
76	76	(4) a basic plan under Chapter 1575;
77	77	(5) a primary care coverage plan under Chapter 1579;
78	78	(6) a plan providing basic coverage under Chapter
79	79	1601;
80	80	(7) a regional or local health care program operated
81	81	under Section 75.104, Health and Safety Code; and
82	82	(8) a self-funded health benefit plan sponsored by a
83	83	professional employer organization under Chapter 91, Labor Code.
84	84	Sec. 1365.052. EXCEPTION. This subchapter does not apply
85	85	to:
86	86	(1) a plan that provides coverage:
87	87	(A) for wages or payments in lieu of wages for a
88	88	period during which an employee is absent from work because of
89	89	sickness or injury; or
90	90	(B) only for hospital expenses; or
91	91	(2) the state Medicaid program, including the Medicaid
92	92	managed care program operated under Chapter 533, Government Code.
93	93	Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit
94	94	plan that provides coverage for hearing aids may not deny an
95	95	enrollee's claim for a hearing aid solely on the basis that the
96	96	price of the hearing aid is more than the benefit available under
97	97	the health benefit plan.
98	98	(b) Notwithstanding Section 1367.253(d), this section
99	99	applies to a health benefit plan subject to Subchapter F, Chapter
100	100	1367.
101	101	(c) Nothing in this section requires a health benefit plan
102	102	to pay an enrollee's claim for a hearing aid in an amount that is
103	103	more than the benefit available under the health benefit plan.
104	104	SECTION 4. This Act applies only to a health benefit plan
105	105	that is delivered, issued for delivery, or renewed on or after
106	106	January 1, 2024.
107	107	SECTION 5. This Act takes effect September 1, 2023.
108	108	* * * * *