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.
Sponsorship: 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 | ||
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| relating to health benefit plan coverage of hearing aids and | ||
| cochlear implants for certain individuals. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Chapter 1367, Insurance Code, is amended by | ||
| adding Subchapter F to read as follows: | ||
| SUBCHAPTER F. HEARING AIDS AND COCHLEAR IMPLANTS | ||
| 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; | ||
| and | ||
| (4) basic coverage under Chapter 1601. | ||
| Sec. 1367.252. EXCEPTION. This subchapter 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); | ||
| (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 | ||
| voting. | ||
| ______________________________ | ||
| 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: _____________________ | ||
| Date | ||
| _____________________ | ||
| Governor | ||
