Bill Text: TX HB2755 | 2021-2022 | 87th Legislature | Comm Sub
Bill Title: Relating to health benefit coverage for general anesthesia in connection with certain pediatric dental services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2021-05-07 - Committee report sent to Calendars [HB2755 Detail]
Download: Texas-2021-HB2755-Comm_Sub.html
| 87R22846 SMT-F | |||
| By: Lucio III | H.B. No. 2755 | ||
| Substitute the following for H.B. No. 2755: | |||
| By: Oliverson | C.S.H.B. No. 2755 | ||
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| relating to health benefit coverage for general anesthesia in | ||
| connection with certain pediatric dental services. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1367, Insurance Code, is amended by | ||
| adding Subchapter G to read as follows: | ||
| SUBCHAPTER G. PEDIATRIC DENTISTRY | ||
| Sec. 1367.301. APPLICABILITY OF SUBCHAPTER. (a) This | ||
| subchapter 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 health maintenance organization operating under | ||
| Chapter 843; | ||
| (4) an approved nonprofit health corporation that | ||
| holds a certificate of authority under Chapter 844; | ||
| (5) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (6) a stipulated premium insurance company operating | ||
| under Chapter 884; | ||
| (7) a fraternal benefit society operating under | ||
| Chapter 885; | ||
| (8) a Lloyd's plan operating under Chapter 941; or | ||
| (9) an exchange operating under Chapter 942. | ||
| (b) Notwithstanding any other law, this subchapter applies | ||
| to: | ||
| (1) a small employer health benefit plan subject to | ||
| Chapter 1501, including coverage provided through a health group | ||
| cooperative under Subchapter B of that chapter; | ||
| (2) a standard health benefit plan issued under | ||
| Chapter 1507; | ||
| (3) a basic coverage plan under Chapter 1551; | ||
| (4) a basic plan under Chapter 1575; | ||
| (5) a primary care coverage plan under Chapter 1579; | ||
| (6) a plan providing basic coverage under Chapter | ||
| 1601; | ||
| (7) health benefits provided by or through a church | ||
| benefits board under Subchapter I, Chapter 22, Business | ||
| Organizations Code; | ||
| (8) a regional or local health care program operated | ||
| under Section 75.104, Health and Safety Code; and | ||
| (9) a self-funded health benefit plan sponsored by a | ||
| professional employer organization under Chapter 91, Labor Code. | ||
| (c) This subchapter 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 in this | ||
| state. | ||
| (d) This subchapter does not apply to a qualified health | ||
| plan if a determination is made under 45 C.F.R. Section 155.170 | ||
| that: | ||
| (1) this subchapter requires the qualified health plan | ||
| to offer benefits in addition to the essential health benefits | ||
| required under 42 U.S.C. Section 18022(b); and | ||
| (2) this state must make payments to defray the cost of | ||
| the additional benefits mandated by this subchapter. | ||
| (e) If a determination described by Subsection (d) is made | ||
| as to a qualified health plan, this subchapter does not apply to a | ||
| non-qualified health plan if the non-qualified health plan is | ||
| offered in the same market as the qualified health plan. | ||
| Sec. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to | ||
| Section 1360.005, a health benefit plan that provides coverage for | ||
| general anesthesia may not exclude from coverage general anesthesia | ||
| services in connection with dental services provided to a covered | ||
| individual if: | ||
| (1) the individual is: | ||
| (A) younger than 13 years of age; and | ||
| (B) unable to undergo the dental service without | ||
| general anesthesia due to a documented physical, mental, or medical | ||
| reason determined by the individual's physician or by the dentist | ||
| providing the dental care; and | ||
| (2) the anesthesia is performed and billed separately | ||
| by: | ||
| (A) a physician anesthesiologist licensed by the | ||
| Texas Medical Board; or | ||
| (B) a dentist anesthesiologist licensed by the | ||
| State Board of Dental Examiners who holds the permit to administer | ||
| general anesthesia under Chapter 258, Occupations Code. | ||
| Sec. 1367.303. COVERAGE NOT REQUIRED. This subchapter does | ||
| not require a health benefit plan to provide coverage for dental | ||
| care or procedures. | ||
| SECTION 2. Subchapter G, Chapter 1367, Insurance Code, as | ||
| added by this Act, applies only to a health benefit plan that is | ||
| delivered, issued for delivery, or renewed on or after January 1, | ||
| 2022. | ||
| SECTION 3. This Act takes effect September 1, 2021. | ||
