Bill Text: TX HB2658 | 2019-2020 | 86th Legislature | Engrossed


Bill Title: Relating to health benefit coverage for hearing aids for children and adults.

Spectrum: Slight Partisan Bill (Democrat 3-1)

Status: (Engrossed - Dead) 2019-05-08 - Referred to Business & Commerce [HB2658 Detail]

Download: Texas-2019-HB2658-Engrossed.html
  86R4681 PMO-D
 
  By: J. Johnson of Dallas, Lucio III, H.B. No. 2658
      González of Dallas, Guillen
 
 
 
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.  Sections 1365.001 through 1365.004, Insurance
  Code, are designated as Subchapter A, Chapter 1365, Insurance Code,
  and a heading is added to Subchapter A 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, 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. 1365.052.  EXCEPTION. (a) 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.
         (b)  This subchapter 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.
         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, 2020.
         SECTION 5.  This Act takes effect September 1, 2019.
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