Texas 2023 - 88th Regular

Texas Senate Bill SB861 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New	Differences
1	1	S.B. No. 861
2	2
3	3
4	4	AN ACT
5	5	relating to coordination of vision and eye care benefits under
6	6	certain health benefit plans and vision benefit plans.
7	7	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	8	SECTION 1. Chapter 1203, Insurance Code, is amended by
9	9	adding Subchapter C to read as follows:
10	10	SUBCHAPTER C. VISION AND EYE CARE BENEFITS
11	11	Sec. 1203.101. DEFINITIONS. In this subchapter:
12	12	(1) "Eye care expenses" means expenses related to
13	13	vision or medical eye care services, procedures, or products.
14	14	(2) "Health benefit plan" means a policy, agreement,
15	15	contract, or evidence of coverage that provides comprehensive
16	16	medical coverage.
17	17	(3) "Vision benefit plan" means a limited-scope
18	18	policy, agreement, contract, or evidence of coverage that provides
19	19	coverage for eye care expenses but does not provide comprehensive
20	20	medical coverage.
21	21	Sec. 1203.102. APPLICABILITY OF SUBCHAPTER. This
22	22	subchapter applies only to a health benefit plan or vision benefit
23	23	plan that provides or arranges for benefits for vision or medical
24	24	eye care services, procedures, or products, including an
25	25	individual, group, blanket, or franchise insurance policy or
26	26	insurance agreement, a group hospital service contract, an evidence
27	27	of coverage, or a vision benefit plan offered by:
28	28	(1) an insurance company;
29	29	(2) a group hospital service corporation operating
30	30	under Chapter 842;
31	31	(3) a health maintenance organization operating under
32	32	Chapter 843;
33	33	(4) a stipulated premium company operating under
34	34	Chapter 884;
35	35	(5) a fraternal benefit society operating under
36	36	Chapter 885;
37	37	(6) a Lloyd's plan operating under Chapter 941;
38	38	(7) an exchange operating under Chapter 942; or
39	39	(8) a person or entity that provides a vision benefit
40	40	plan.
41	41	Sec. 1203.103. EXCEPTION. This subchapter does not apply
42	42	to a supplemental insurance policy that only pays benefits directly
43	43	to the policyholder.
44	44	Sec. 1203.104. COORDINATION OF BENEFITS BETWEEN PRIMARY AND
45	45	SECONDARY PLAN ISSUERS. (a) This section applies if:
46	46	(1) an enrollee is covered by at least two different
47	47	health benefit plans or vision benefit plans; and
48	48	(2) each plan provides the enrollee coverage for the
49	49	same vision or medical eye care services, procedures, or products.
50	50	(b) The issuer of the primary health benefit plan or vision
51	51	benefit plan, as determined under a coordination of benefits
52	52	provision applicable to the plan, is responsible for eye care
53	53	expenses covered under the plan up to the full amount of any plan
54	54	coverage limit applicable to the covered eye care expenses.
55	55	(c) Before the plan coverage limit described by Subsection
56	56	(b) is reached, the issuer of a secondary health benefit plan or
57	57	vision benefit plan, as determined under a coordination of benefits
58	58	provision applicable to the plan, is responsible only for eye care
59	59	expenses covered under the plan that are not covered under the
60	60	health benefit plan or vision benefit plan issued by the primary
61	61	plan issuer.
62	62	(d) After the plan coverage limit described by Subsection
63	63	(b) has been reached, the secondary plan issuer, in addition to the
64	64	responsibilities described by Subsection (c), is responsible for
65	65	any eye care expenses covered by both plans that exceed the plan
66	66	coverage limit described by Subsection (b) up to the coverage limit
67	67	of the secondary plan.
68	68	(e) When an enrollee is covered by more than one health
69	69	benefit plan or vision benefit plan that provides benefits for eye
70	70	care expenses, the enrollee may use each plan on the same date of
71	71	service up to the coverage limit of each plan.
72	72	(f) A vision benefit plan issuer shall coordinate benefits
73	73	with a health benefit plan issuer if both provide benefits for eye
74	74	care expenses.
75	75	(g) A vision benefit plan issuer may not require a claim
76	76	denial before adjudicating a claim up to the coverage limit of the
77	77	plan.
78	78	(h) Nothing in this section prevents a secondary plan issuer
79	79	from requiring proof that a related claim has been submitted to a
80	80	primary plan issuer for purposes of determining the remaining
81	81	balance up to the secondary plan's coverage limits.
82	82	(i) If a secondary plan issuer requires proof that a related
83	83	claim has been submitted to a primary plan issuer as described by
84	84	Subsection (h), the mechanism of providing proof must be through an
85	85	online submission.
86	86	Sec. 1203.105. CERTAIN COORDINATION OF BENEFITS PROVISIONS
87	87	PROHIBITED. (a) A health benefit plan or vision benefit plan
88	88	subject to this subchapter may not be delivered, issued for
89	89	delivery, or renewed in this state if:
90	90	(1) a provision of the plan excludes or reduces the
91	91	payment of benefits for eye care expenses to or on behalf of an
92	92	enrollee;
93	93	(2) the reason for the exclusion or reduction is that
94	94	eye care benefits are payable or have been paid to or on behalf of
95	95	the enrollee under another plan; and
96	96	(3) the exclusion or reduction would apply before the
97	97	full amount of the eye care expenses incurred by the enrollee and
98	98	covered by both plans have been paid or reimbursed or the full
99	99	amount of the applicable coverage limit of the plan containing the
100	100	exclusion or reduction is reached.
101	101	(b) Nothing in this section requires a secondary plan issuer
102	102	to pay an amount that, when added to a payment amount made by a
103	103	primary plan issuer, would exceed the usual and customary billed
104	104	charges of the health care provider.
105	105	Sec. 1203.106. CERTAIN COORDINATION OF BENEFITS PROVISIONS
106	106	VOID. A provision of a health benefit plan or vision benefit plan
107	107	that violates this subchapter is void.
108	108	Sec. 1203.107. RULES. The commissioner may adopt rules
109	109	necessary to implement this subchapter.
110	110	SECTION 2. The change in law made by this Act applies only
111	111	to a health benefit plan or vision benefit plan that is delivered,
112	112	issued for delivery, or renewed on or after January 1, 2024. A plan
113	113	delivered, issued for delivery, or renewed before January 1, 2024,
114	114	is governed by the law as it existed immediately before the
115	115	effective date of this Act, and that law is continued in effect for
116	116	that purpose.
117	117	SECTION 3. This Act takes effect September 1, 2023.
118	118	______________________________ ______________________________
119	119	President of the Senate Speaker of the House
120	120	I hereby certify that S.B. No. 861 passed the Senate on
121	121	April 20, 2023, by the following vote: Yeas 31, Nays 0.
122	122	______________________________
123	123	Secretary of the Senate
124	124	I hereby certify that S.B. No. 861 passed the House on
125	125	April 28, 2023, by the following vote: Yeas 147, Nays 0,
126	126	one present not voting.
127	127	______________________________
128	128	Chief Clerk of the House
129	129	Approved:
130	130	______________________________
131	131	Date
132	132	______________________________
133	133	Governor