Bill Text: TX HB4442 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to health benefit coverage for general anesthesia in connection with certain pediatric dental services.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-26 - Referred to Insurance [HB4442 Detail]
Download: Texas-2019-HB4442-Introduced.html
86R13547 PMO-D | ||
By: Lucio III | H.B. No. 4442 |
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relating to health benefit coverage for general anesthesia in | ||
connection with certain pediatric dental services. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1367, Insurance Code, is amended by | ||
adding Subchapter G to read as follows: | ||
SUBCHAPTER G. PEDIATRIC DENTISTRY | ||
Sec. 1367.3001. APPLICABILITY OF SUBCHAPTER. (a) This | ||
subchapter applies only to a health benefit plan that provides | ||
benefits for medical, surgical, or dental 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 issued 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) 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) health benefits provided by or through a church | ||
benefits board under Subchapter I, Chapter 22, Business | ||
Organizations Code; | ||
(8) group health coverage made available by a school | ||
district in accordance with Section 22.004, Education Code; | ||
(9) the state Medicaid program, including the Medicaid | ||
managed care program operated under Chapter 533, Government Code; | ||
(10) the child health plan program under Chapter 62, | ||
Health and Safety Code; | ||
(11) a regional or local health care program operated | ||
under Section 75.104, Health and Safety Code; | ||
(12) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code; | ||
(13) county employee group health benefits provided | ||
under Chapter 157, Local Government Code; and | ||
(14) health and accident coverage provided by a risk | ||
pool created under Chapter 172, Local Government Code. | ||
(c) This subchapter applies to coverage under a group health | ||
benefit plan provided to a resident of this state regardless of | ||
whether the group policy, agreement, or contract is delivered, | ||
issued for delivery, or renewed in this state. | ||
Sec. 1367.3002. EXCEPTIONS. (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 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(g)(1)); | ||
(3) a workers' compensation insurance policy; | ||
(4) medical payment insurance coverage provided under | ||
a motor vehicle insurance policy; or | ||
(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 1367.3001. | ||
(b) This subchapter does not apply to an individual health | ||
benefit plan issued on or before March 23, 2010, that has not had | ||
any significant changes since that date that reduce benefits or | ||
increase costs to the individual. | ||
Sec. 1367.3003. COVERAGE FOR GENERAL ANESTHESIA. A health | ||
benefit plan that provides coverage for dental services may not | ||
exclude from coverage general anesthesia services in connection | ||
with dental services provided to a covered individual who is: | ||
(1) younger than 18 years of age; and | ||
(2) unable to undergo the dental service in an office | ||
setting or under local anesthesia due to a documented physical, | ||
mental, or medical reason determined by the individual's physician | ||
or by the dentist providing the dental care. | ||
Sec. 1367.3004. CONDITIONAL EXCEPTION. This subchapter | ||
does not apply to a qualified health plan 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 is required to defray the cost of the | ||
benefits mandated under this subchapter. | ||
SECTION 2. If before implementing any provision of this Act | ||
a state agency determines that a waiver or authorization from a | ||
federal agency is necessary for implementation of that provision, | ||
the agency affected by the provision shall request the waiver or | ||
authorization and may delay implementing that provision until the | ||
waiver or authorization is granted. | ||
SECTION 3. Subchapter G, Chapter 1367, Insurance Code, as | ||
added by this Act, applies only to a health benefit plan that is | ||
delivered, issued for delivery, or renewed on or after January 1, | ||
2020. | ||
SECTION 4. This Act takes effect September 1, 2019. |