| 1 | 1 | | 89R1426 CJD-F |
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| 2 | 2 | | By: Gervin-Hawkins H.B. No. 261 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to health benefit coverage for general anesthesia in |
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| 10 | 10 | | connection with certain pediatric dental services. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Chapter 1367, Insurance Code, is amended by |
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| 13 | 13 | | adding Subchapter G to read as follows: |
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| 14 | 14 | | SUBCHAPTER G. PEDIATRIC DENTISTRY |
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| 15 | 15 | | Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This |
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| 16 | 16 | | subchapter applies only to a health benefit plan that provides |
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| 17 | 17 | | benefits for medical or surgical expenses incurred as a result of a |
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| 18 | 18 | | health condition, accident, or sickness, including an individual, |
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| 19 | 19 | | group, blanket, or franchise insurance policy or insurance |
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| 20 | 20 | | agreement, a group hospital service contract, or an individual or |
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| 21 | 21 | | group evidence of coverage or similar coverage document that is |
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| 22 | 22 | | offered by: |
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| 23 | 23 | | (1) an insurance company; |
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| 24 | 24 | | (2) a group hospital service corporation operating |
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| 25 | 25 | | under Chapter 842; |
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| 26 | 26 | | (3) a health maintenance organization operating under |
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| 27 | 27 | | Chapter 843; |
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| 28 | 28 | | (4) an approved nonprofit health corporation that |
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| 29 | 29 | | holds a certificate of authority under Chapter 844; |
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| 30 | 30 | | (5) a multiple employer welfare arrangement that holds |
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| 31 | 31 | | a certificate of authority under Chapter 846; |
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| 32 | 32 | | (6) a stipulated premium insurance company operating |
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| 33 | 33 | | under Chapter 884; |
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| 34 | 34 | | (7) a fraternal benefit society operating under |
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| 35 | 35 | | Chapter 885; |
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| 36 | 36 | | (8) a Lloyd's plan operating under Chapter 941; or |
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| 37 | 37 | | (9) an exchange operating under Chapter 942. |
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| 38 | 38 | | (b) Notwithstanding any other law, this subchapter applies |
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| 39 | 39 | | to: |
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| 40 | 40 | | (1) a small employer health benefit plan subject to |
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| 41 | 41 | | Chapter 1501, including coverage provided through a health group |
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| 42 | 42 | | cooperative under Subchapter B of that chapter; |
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| 43 | 43 | | (2) a standard health benefit plan issued under |
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| 44 | 44 | | Chapter 1507; |
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| 45 | 45 | | (3) a basic coverage plan under Chapter 1551; |
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| 46 | 46 | | (4) a basic plan under Chapter 1575; |
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| 47 | 47 | | (5) a primary care coverage plan under Chapter 1579; |
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| 48 | 48 | | (6) a plan providing basic coverage under Chapter |
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| 49 | 49 | | 1601; |
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| 50 | 50 | | (7) a regional or local health care program operated |
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| 51 | 51 | | under Section 75.104, Health and Safety Code; and |
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| 52 | 52 | | (8) a self-funded health benefit plan sponsored by a |
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| 53 | 53 | | professional employer organization under Chapter 91, Labor Code. |
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| 54 | 54 | | Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to |
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| 55 | 55 | | Section 1360.005, a health benefit plan that provides coverage for |
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| 56 | 56 | | general anesthesia may not exclude from coverage medically |
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| 57 | 57 | | necessary general anesthesia services in connection with dental |
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| 58 | 58 | | services provided to a covered individual if: |
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| 59 | 59 | | (1) the individual is: |
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| 60 | 60 | | (A) younger than 13 years of age; and |
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| 61 | 61 | | (B) unable to undergo the dental service without |
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| 62 | 62 | | general anesthesia due to a documented physical, mental, or medical |
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| 63 | 63 | | reason; and |
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| 64 | 64 | | (2) the anesthesia is performed by a qualified |
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| 65 | 65 | | provider of anesthesia services. |
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| 66 | 66 | | Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does |
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| 67 | 67 | | not require a health benefit plan to provide coverage for dental |
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| 68 | 68 | | care or procedures. |
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| 69 | 69 | | SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as |
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| 70 | 70 | | added by this Act, applies only to a health benefit plan that is |
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| 71 | 71 | | delivered, issued for delivery, or renewed on or after January 1, |
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| 72 | 72 | | 2026. |
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| 73 | 73 | | SECTION 3. This Act takes effect September 1, 2025. |
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