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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for vaccination against |
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human papillomavirus. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1380 to read as follows: |
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CHAPTER 1380. COVERAGE FOR VACCINATION AGAINST HUMAN |
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PAPILLOMAVIRUS |
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SUBCHAPTER A. GENERAL PROVISIONS |
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Sec. 1380.001. DEFINITION. In this chapter, "enrollee" |
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means an individual entitled to coverage under a health benefit |
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plan. |
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Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) an exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) This chapter applies to group health coverage made |
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available by a school district in accordance with Section 22.004, |
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Education Code. |
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(c) Notwithstanding Section 172.014, Local Government Code, |
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or any other law, this chapter applies to health and accident |
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coverage provided by a risk pool created under Chapter 172, Local |
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Government Code. |
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(d) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(e) Notwithstanding any other law, a standard health |
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benefit plan provided under Chapter 1507 must provide the coverage |
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required by this chapter. |
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(f) Notwithstanding Section 1501.251 or any other law, this |
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chapter applies to coverage under a small employer health benefit |
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plan subject to Chapter 1501. |
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(g) Notwithstanding Section 1502.052 or any other law, this |
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chapter applies to a children's health benefit plan issued under |
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Chapter 1502. |
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Sec. 1380.003. EXCEPTIONS. This chapter does not apply to: |
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(1) a plan that provides coverage: |
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(A) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(B) as a supplement to a liability insurance |
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policy; |
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(C) for credit insurance; |
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(D) only for dental or vision care; |
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(E) only for hospital expenses; or |
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(F) only for indemnity for hospital confinement; |
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(2) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; or |
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(5) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides benefit coverage so comprehensive that the policy |
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is a health benefit plan as described by Section 1380.002. |
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Sec. 1380.004. RULES. The commissioner, in accordance with |
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Subchapter A, Chapter 36, may adopt rules to implement this |
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chapter. |
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[Sections 1380.005-1380.050 reserved for expansion] |
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SUBCHAPTER B. COVERAGE FOR VACCINATION |
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Sec. 1380.051. REQUIRED COVERAGE. A health benefit plan |
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issuer shall provide benefits for vaccination of an enrollee |
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against human papillomavirus and for any expenses related to |
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providing the vaccination. This section does not require coverage |
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for a vaccination that the enrollee's physician has determined to |
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be contraindicated for the enrollee. |
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Sec. 1380.052. DEDUCTIBLE, COINSURANCE, AND COPAYMENT |
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REQUIREMENTS. The benefits required under this chapter may be made |
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subject to a deductible, coinsurance, or copayment requirement |
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comparable to other deductible, coinsurance, or copayment |
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requirements applicable to benefits for immunization under the |
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health benefit plan. |
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SECTION 2. This Act applies only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2008. A health benefit plan that is delivered, issued |
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for delivery, or renewed before January 1, 2008, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2007. |