Bill Text: TX HB490 | 2017-2018 | 85th Legislature | Enrolled

Bill Title: Relating to health benefit plan coverage of hearing aids and cochlear implants for certain individuals.

Spectrum: Slight Partisan Bill (Republican 18-9)

Status: (Passed) 2017-06-15 - Effective on 9/1/17 [HB490 Detail]

Download: Texas-2017-HB490-Enrolled.html
  H.B. No. 490
  relating to health benefit plan coverage of hearing aids and
  cochlear implants for certain individuals.
         SECTION 1.  Chapter 1367, Insurance Code, is amended by
  adding Subchapter F to read as follows:
         Sec. 1367.251.  APPLICABILITY OF SUBCHAPTER.  (a)  This
  subchapter 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 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 within or
  outside this state.
         (c)  This subchapter applies to a self-funded health benefit
  plan sponsored by a professional employer organization under
  Chapter 91, Labor Code.
         (d)  Notwithstanding Section 22.409, Business Organizations
  Code, or any other law, this subchapter applies to health benefits
  provided by or through a church benefits board under Subchapter I,
  Chapter 22, Business Organizations Code.
         (e)  Notwithstanding Section 75.104, Health and Safety Code,
  or any other law, this subchapter applies to a regional or local
  health care program operated under that section.
         (f)  Notwithstanding any other law, a standard health
  benefit plan provided under Chapter 1507 must provide the coverage
  required by this subchapter.
         (g)  Notwithstanding any provision in Chapter 1551, 1575,
  1579, or 1601 or any other law, this subchapter 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;
               (4)  basic coverage under Chapter 1601.
         Sec. 1367.252.  EXCEPTION.  This subchapter does not apply
               (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
                     (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);
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (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 1367.251; or
               (6)  the state Medicaid program, including the Medicaid
  managed care program operated under Chapter 533, Government Code.
         Sec. 1367.253.  COVERAGE REQUIRED. (a) A health benefit
  plan must provide coverage for the cost of a medically necessary
  hearing aid or cochlear implant and related services and supplies
  for a covered individual who is 18 years of age or younger.
         (b)  Coverage required under this section:
               (1)  must include:
                     (A)  fitting and dispensing services and the
  provision of ear molds as necessary to maintain optimal fit of
  hearing aids;
                     (B)  any treatment related to hearing aids and
  cochlear implants, including coverage for habilitation and
  rehabilitation as necessary for educational gain; and
                     (C)  for a cochlear implant, an external speech
  processor and controller with necessary components replacement
  every three years; and
               (2)  is limited to:
                     (A)  one hearing aid in each ear every three
  years; and
                     (B)  one cochlear implant in each ear with
  internal replacement as medically or audiologically necessary.
         (c)  Except as provided by Subsections (b) and (d), coverage
  required under this section:
               (1)  may not be less favorable than coverage for
  physical illness generally under the plan; and
               (2)  must be subject to durational limits and
  coinsurance factors no less favorable than coverage provided for
  physical illness generally under the plan.
         (d)  Coverage required under this section is subject to any
  provision that applies generally to coverage provided for durable
  medical equipment benefits under the plan, including a provision
  relating to deductibles, coinsurance, or prior authorization.
         (e)  This section does not apply to a qualified health plan
  defined by 45 C.F.R. Section 155.20 if a determination is made under
  45 C.F.R. Section 155.170 that:
               (1)  this subchapter requires the 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.
         SECTION 2.  The change in law made by this Act applies only
  to a health benefit plan delivered, issued for delivery, or renewed
  on or after January 1, 2018. A health benefit plan 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.
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
         I certify that H.B. No. 490 was passed by the House on April
  25, 2017, by the following vote:  Yeas 121, Nays 21, 2 present, not
  Chief Clerk of the House   
         I certify that H.B. No. 490 was passed by the Senate on May
  22, 2017, by the following vote:  Yeas 27, Nays 4.
  Secretary of the Senate    
  APPROVED:  _____________________