Bill Text: TX HB224 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to health benefit plan coverage of preexisting conditions.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2017-02-13 - Referred to Insurance [HB224 Detail]
Download: Texas-2017-HB224-Introduced.html
| 85R3680 MEW-D | ||
| By: Rodriguez of Travis | H.B. No. 224 | |
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| relating to health benefit plan coverage of preexisting conditions. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle G, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1509 to read as follows: | ||
| CHAPTER 1509. COVERAGE OF PREEXISTING CONDITIONS | ||
| Sec. 1509.001. DEFINITION. In this chapter, "preexisting | ||
| condition" means a condition present before the effective date of | ||
| an individual's coverage under a health benefit plan. | ||
| Sec. 1509.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
| applies only to a health benefit plan, including a small employer | ||
| health benefit plan written under Chapter 1501 or coverage provided | ||
| through a health group cooperative under Subchapter B of that | ||
| chapter, 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 Lloyd's plan operating under Chapter 941; | ||
| (5) a stipulated premium insurance company operating | ||
| under Chapter 884; | ||
| (6) a reciprocal exchange operating under Chapter 942; | ||
| (7) a health maintenance organization operating under | ||
| Chapter 843; | ||
| (8) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; or | ||
| (9) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844. | ||
| (b) This chapter applies to coverage under a group health | ||
| benefit plan described by Subsection (a) provided to a resident of | ||
| this state, regardless of whether the group policy, agreement, or | ||
| contract is delivered, issued for delivery, or renewed within or | ||
| outside this state. | ||
| (c) This chapter applies to group health coverage made | ||
| available by a school district in accordance with Section 22.004, | ||
| Education Code. | ||
| (d) This chapter applies to a self-funded health benefit | ||
| plan sponsored by a professional employer organization under | ||
| Chapter 91, Labor Code. | ||
| (e) Notwithstanding Section 22.409, Business Organizations | ||
| Code, or any other law, this chapter applies to health benefits | ||
| provided by or through a church benefits board under Subchapter I, | ||
| Chapter 22, Business Organizations Code. | ||
| (f) Notwithstanding Sections 157.008 and 157.106, Local | ||
| Government Code, or any other law, this chapter applies to a county | ||
| employee health benefit plan provided under Chapter 157, Local | ||
| Government Code. | ||
| (g) Notwithstanding Section 75.104, Health and Safety Code, | ||
| or any other law, this chapter applies to a regional or local health | ||
| care program operated under that section. | ||
| (h) 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. | ||
| (i) 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. | ||
| (j) Notwithstanding any other law, a standard health | ||
| benefit plan provided under Chapter 1507 must provide the coverage | ||
| required by this chapter. | ||
| (k) To the extent allowed by federal law, the child health | ||
| plan program operated under Chapter 62, Health and Safety Code, the | ||
| state Medicaid program, and a managed care organization that | ||
| contracts with the Health and Human Services Commission to provide | ||
| health care services to recipients through a managed care plan | ||
| shall provide the coverage required under this chapter to a | ||
| recipient. | ||
| Sec. 1509.003. EXCEPTIONS. (a) 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 Medicare supplemental policy as defined by | ||
| Section 1882(g)(1), Social Security Act (42 U.S.C. Section | ||
| 1395ss(g)(1)); | ||
| (3) a workers' compensation insurance policy; | ||
| (4) medical payment insurance coverage provided under | ||
| a motor vehicle insurance policy; or | ||
| (5) 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 1509.002. | ||
| (b) This chapter does not apply to an individual health | ||
| benefit plan issued on or before March 23, 2010, that has not had | ||
| any significant changes since that date that reduce benefits or | ||
| increase costs to the individual. | ||
| Sec. 1509.004. PREEXISTING CONDITION RESTRICTIONS | ||
| PROHIBITED. Notwithstanding any other law, a health benefit plan | ||
| issuer may not: | ||
| (1) deny an individual's application for coverage or | ||
| refuse to enroll an individual in a group health benefit plan due to | ||
| a preexisting condition; | ||
| (2) limit or exclude coverage under the health benefit | ||
| plan for the treatment of a preexisting condition otherwise covered | ||
| under the plan; or | ||
| (3) charge the individual more for coverage than the | ||
| health benefit plan issuer charges an individual who does not have a | ||
| preexisting condition. | ||
| SECTION 2. The change in law made by this Act applies only | ||
| to a health benefit plan that is delivered, issued for delivery, or | ||
| renewed on or after January 1, 2018. A health benefit plan that is | ||
| delivered, issued for delivery, or renewed before January 1, 2018, | ||
| 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, 2017. | ||
