Bill Text: TX HB2228 | 2011-2012 | 82nd Legislature | Introduced
Bill Title: Relating to health benefit plan coverage for certain physical injuries that are self-inflicted by a minor.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2011-03-10 - Referred to Insurance [HB2228 Detail]
Download: Texas-2011-HB2228-Introduced.html
82R5709 RWG-D | ||
By: Coleman | H.B. No. 2228 |
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relating to health benefit plan coverage for certain physical | ||
injuries that are self-inflicted by a minor. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended | ||
by adding Chapter 1373 to read as follows: | ||
CHAPTER 1373. COVERAGE FOR CERTAIN SELF-INFLICTED | ||
PHYSICAL INJURIES BY MINORS | ||
Sec. 1373.001. DEFINITIONS. In this chapter: | ||
(1) "Enrollee" means an individual entitled to | ||
coverage under a health benefit plan. | ||
(2) "Serious mental illness" has the meaning assigned | ||
by Section 1355.001 and also includes a diagnosable behavioral or | ||
emotional disorder or a neuropsychiatric condition: | ||
(A) that results in a serious disability | ||
requiring sustained treatment interventions; | ||
(B) that is of sufficient duration to meet | ||
diagnostic criteria specified in the American Psychiatric | ||
Association's Diagnostic and Statistical Manual of Mental | ||
Disorders designated DSM-IV-TR; and | ||
(C) with respect to which the affected person | ||
exhibits impairment in thought, perception, affect, or behavior | ||
that substantially interferes with or limits the person's role or | ||
functioning in the person's community, school, family, or peer | ||
group. | ||
Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
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 fraternal benefit society operating under | ||
Chapter 885; | ||
(4) a stipulated premium insurance 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. | ||
(b) This chapter applies to group health coverage made | ||
available by a school district in accordance with Section 22.004, | ||
Education Code. | ||
(c) Notwithstanding Section 172.014, Local Government Code, | ||
or any other law, this chapter applies to health and accident | ||
coverage provided by a risk pool created under Chapter 172, Local | ||
Government Code. | ||
(d) Notwithstanding any provision in Chapter 1551, 1575, | ||
1579, or 1601 or any other law, this chapter applies to: | ||
(1) a basic coverage plan under Chapter 1551; | ||
(2) a basic plan under Chapter 1575; | ||
(3) a primary care coverage plan under Chapter 1579; | ||
and | ||
(4) basic coverage under Chapter 1601. | ||
(e) Notwithstanding any other law, a standard health | ||
benefit plan provided under Chapter 1507 must provide the coverage | ||
required by this chapter. | ||
Sec. 1373.003. EXCEPTION. This chapter does not apply to: | ||
(1) a plan that provides coverage: | ||
(A) for wages or payments in lieu of wages for a | ||
period during which an employee is absent from work because of | ||
sickness or injury; | ||
(B) as a supplement to a liability insurance | ||
policy; | ||
(C) for credit insurance; | ||
(D) only for dental or vision care; | ||
(E) only for hospital expenses; or | ||
(F) only for indemnity for hospital confinement; | ||
(2) a small employer health benefit plan written under | ||
Chapter 1501, except when an independent school district elects to | ||
participate in a small employer market in accordance with Section | ||
1501.009; | ||
(3) a Medicare supplemental policy as defined by | ||
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); | ||
(4) a workers' compensation insurance policy; | ||
(5) medical payment insurance coverage provided under | ||
a motor vehicle insurance policy; or | ||
(6) a long-term care 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 1373.002. | ||
Sec. 1373.004. COVERAGE REQUIRED. Regardless of whether a | ||
health benefit plan provides mental health coverage, a health | ||
benefit plan must provide coverage for an enrollee, from birth | ||
through the date the enrollee is 18 years of age, for a physical | ||
injury to the enrollee that is self-inflicted: | ||
(1) in an attempt to commit suicide, regardless of: | ||
(A) the state of mental health of the enrollee; | ||
or | ||
(B) whether the injury results in the death of | ||
the enrollee; or | ||
(2) by an enrollee with a serious mental illness. | ||
Sec. 1373.005. DEDUCTIBLE, COINSURANCE, AND COPAYMENT | ||
REQUIREMENTS. The benefits required under this chapter may not be | ||
made subject to a deductible, coinsurance, or copayment requirement | ||
that exceeds the deductible, coinsurance, or copayment | ||
requirements applicable to other physical injury benefits provided | ||
under the health benefit plan. | ||
Sec. 1373.006. RULES. The commissioner shall adopt rules as | ||
necessary to administer this chapter. | ||
SECTION 2. This Act applies only to a health benefit plan | ||
that is delivered, issued for delivery, or renewed on or after | ||
January 1, 2012. A health benefit plan that is delivered, issued | ||
for delivery, or renewed before January 1, 2012, 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 3. This Act takes effect September 1, 2011. |