Bill Text: TX SB1349 | 2015-2016 | 84th Legislature | Introduced
Bill Title: Relating to coordination of dental benefits under certain insurance policies.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2015-03-18 - Referred to Business & Commerce [SB1349 Detail]
Download: Texas-2015-SB1349-Introduced.html
84R4915 KKR-F | ||
By: Hinojosa | S.B. No. 1349 |
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relating to coordination of dental benefits under certain insurance | ||
policies. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1203, Insurance Code, is amended by | ||
adding Subchapter B to read as follows: | ||
SUBCHAPTER B. DENTAL INSURANCE | ||
Sec. 1203.051. APPLICABILITY OF SUBCHAPTER. This | ||
subchapter applies only to an insurance policy that provides | ||
benefits for dental expenses, including an individual, group, | ||
blanket, or franchise insurance policy or insurance agreement, or a | ||
group hospital service contract, 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 stipulated premium company operating under | ||
Chapter 884; | ||
(5) a reciprocal exchange operating under Chapter 942; | ||
or | ||
(6) a Lloyd's plan operating under Chapter 941. | ||
Sec. 1203.052. COORDINATION OF BENEFITS BETWEEN PRIMARY AND | ||
SECONDARY PROVIDER. (a) This section applies if: | ||
(1) an insured is covered by at least two different | ||
insurance policies; and | ||
(2) each policy provides the insured dental benefits. | ||
(b) The primary insurer, as determined under a coordination | ||
of benefits provision applicable to the policies, is responsible | ||
for dental expenses covered under the insurance policy issued by | ||
the primary insurer up to the full amount of the applicable policy | ||
limit. | ||
(c) Before the policy limit described by Subsection (b) is | ||
reached, the secondary insurer, as determined under a coordination | ||
of benefits provision applicable to the policies, is responsible | ||
only for dental expenses covered under the insurance policy issued | ||
by the secondary insurer that are not covered under the policy | ||
issued by the primary insurer. | ||
(d) After the policy limit described by Subsection (b) has | ||
been reached, the secondary insurer, in addition to the | ||
responsibility described by Subsection (c), is responsible for any | ||
dental expenses covered by both policies that exceed the policy | ||
limit described by Subsection (b), up to the full amount of the | ||
applicable policy limit of the insurance policy issued by the | ||
secondary insurer. | ||
Sec. 1203.053. CERTAIN COORDINATION OF BENEFITS PROVISIONS | ||
PROHIBITED. An insurance policy subject to this subchapter may not | ||
be delivered, issued for delivery, or renewed in this state if: | ||
(1) a provision of the policy excludes or reduces the | ||
payment of benefits for dental expenses to or on behalf of an | ||
insured; | ||
(2) the reason for the exclusion or reduction is that | ||
dental benefits are payable or have been paid to or on behalf of the | ||
insured under another insurance policy; and | ||
(3) the exclusion or reduction would apply before the | ||
full amount of the dental expenses incurred by the insured and | ||
covered by both policies have been paid or reimbursed or the full | ||
amount of the applicable policy limit of the policy containing the | ||
exclusion or reduction is reached. | ||
Sec. 1203.054. CERTAIN COORDINATION OF BENEFITS PROVISIONS | ||
VOID. A provision of an insurance policy that violates Section | ||
1203.053 is void. | ||
SECTION 2. Chapter 1203, Insurance Code, is amended by | ||
designating Sections 1203.001 through 1203.003 as Subchapter A and | ||
adding a subchapter heading to read as follows: | ||
SUBCHAPTER A. SUPPLEMENTAL INSURANCE POLICIES | ||
SECTION 3. Section 1203.001, Insurance Code, is amended to | ||
read as follows: | ||
Sec. 1203.001. APPLICABILITY OF SUBCHAPTER [ |
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This subchapter [ |
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(1) a policy of group accident and health insurance as | ||
described by Chapter 1251; | ||
(2) a policy of blanket accident and health insurance | ||
as described by Chapter 1251; | ||
(3) a policy of individual accident and health | ||
insurance as defined by Section 1201.001; or | ||
(4) an evidence of coverage as defined by Section | ||
843.002. | ||
(b) This subchapter [ |
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individual accident and health insurance policy that is designed to | ||
fully integrate with other policies through a variable deductible. | ||
SECTION 4. The change in law made by this Act applies only | ||
to an insurance policy that is delivered, issued for delivery, or | ||
renewed on or after January 1, 2016. A policy delivered, issued for | ||
delivery, or renewed before January 1, 2016, 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 5. This Act takes effect September 1, 2015. |