| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
| |
|
|
relating to health benefit coverage for hearing aids for children |
|
|
and adults. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Chapter 1365, Insurance Code, is amended by |
|
|
designating Sections 1365.001 through 1365.004 as Subchapter A and |
|
|
adding a subchapter heading to read as follows: |
|
|
SUBCHAPTER A. GENERAL PROVISIONS |
|
|
SECTION 2. Sections 1365.001 and 1365.002, Insurance Code, |
|
|
are amended to read as follows: |
|
|
Sec. 1365.001. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This |
|
|
subchapter [chapter] applies only to a group health benefit plan |
|
|
that provides hospital and medical coverage on an expense-incurred, |
|
|
service, or prepaid basis, including a group policy, contract, or |
|
|
plan that is offered in this state by: |
|
|
(1) an insurer; |
|
|
(2) a group hospital service corporation operating |
|
|
under Chapter 842; or |
|
|
(3) a health maintenance organization operating under |
|
|
Chapter 843. |
|
|
Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
|
|
LAW. The provisions of Chapter 1201, including provisions relating |
|
|
to the applicability, purpose, and enforcement of that chapter, |
|
|
construction of policies under that chapter, rulemaking under that |
|
|
chapter, and definitions of terms applicable in that chapter, apply |
|
|
to this subchapter [chapter]. |
|
|
SECTION 3. Chapter 1365, Insurance Code, is amended by |
|
|
adding Subchapter B to read as follows: |
|
|
SUBCHAPTER B. HEARING AID COVERAGE |
|
|
Sec. 1365.051. APPLICABILITY. (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 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) 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) 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) a regional or local health care program operated |
|
|
under Section 75.104, Health and Safety Code; and |
|
|
(8) a self-funded health benefit plan sponsored by a |
|
|
professional employer organization under Chapter 91, Labor Code. |
|
|
Sec. 1365.052. 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; or |
|
|
(B) only for hospital expenses; or |
|
|
(2) the state Medicaid program, including the Medicaid |
|
|
managed care program operated under Chapter 533, Government Code. |
|
|
Sec. 1365.053. CHOICE OF HEARING AID. (a) A health benefit |
|
|
plan that provides coverage for hearing aids may not deny an |
|
|
enrollee's claim for a hearing aid solely on the basis that the |
|
|
price of the hearing aid is more than the benefit available under |
|
|
the health benefit plan. |
|
|
(b) Notwithstanding Section 1367.253(d), this section |
|
|
applies to a health benefit plan subject to Subchapter F, Chapter |
|
|
1367. |
|
|
(c) Nothing in this section requires a health benefit plan |
|
|
to pay an enrollee's claim for a hearing aid in an amount that is |
|
|
more than the benefit available under the health benefit plan. |
|
|
SECTION 4. This Act applies only to a health benefit plan |
|
|
that is delivered, issued for delivery, or renewed on or after |
|
|
January 1, 2024. |
|
|
SECTION 5. This Act takes effect September 1, 2023. |
|
|
|
|
|
* * * * * |