Bill Text: TX HB490 | 2017-2018 | 85th Legislature | Comm Sub
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Comm_Sub.html
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-Comm_Sub.html
By: Anderson of Dallas, et al. | H.B. No. 490 | |
(Senate Sponsor - Kolkhorst) | ||
(In the Senate - Received from the House April 26, 2017; | ||
May 5, 2017, read first time and referred to Committee on Business & | ||
Commerce; May 17, 2017, reported favorably by the following vote: | ||
Yeas 9, Nays 0; May 17, 2017, sent to printer.) | ||
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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. | ||
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