H.B. No. 490

	AN ACT
	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