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AN ACT
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relating to requirements in certain health benefit plans that |
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certain health care services be obtained in a foreign country. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle A, Title 8, Insurance Code, is amended |
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by adding Chapter 1215 to read as follows: |
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CHAPTER 1215. OUT-OF-COUNTRY COVERAGE PROHIBITED |
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Sec. 1215.001. DEFINITIONS. In this chapter: |
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(1) "Enrollee" means an individual entitled to |
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coverage under a health benefit plan. |
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(2) "Foreign country" means a governmental unit other |
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than: |
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(A) the United States; |
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(B) a state, district, commonwealth, territory, |
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or insular possession of the United States; |
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(C) the Panama Canal Zone; or |
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(D) the Trust Territory of the Pacific Islands. |
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(3) "Health care service" means a service to diagnose, |
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prevent, alleviate, cure, or heal a health condition, sickness, or |
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injury that is provided to an enrollee by a physician or other |
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health care provider. |
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Sec. 1215.002. 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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health care services, including medical or surgical expenses, |
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incurred as a result of a health condition, accident, or sickness, |
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including: |
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(1) an individual, group, blanket, or franchise |
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insurance policy or insurance agreement, a group hospital service |
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contract, or an individual or group evidence of coverage that is |
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offered by: |
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(A) an insurance company; |
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(B) a group hospital service corporation |
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operating under Chapter 842; |
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(C) a fraternal benefit society operating under |
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Chapter 885; |
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(D) a stipulated premium company operating under |
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Chapter 884; or |
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(E) a health maintenance organization operating |
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under Chapter 843; and |
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(2) to the extent permitted by the Employee Retirement |
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Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a |
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health benefit plan that is offered by: |
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(A) a multiple employer welfare arrangement as |
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defined by Section 3 of that Act; or |
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(B) another analogous benefit arrangement. |
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(b) For purposes of Subsection (a), a health benefit plan |
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includes a consumer choice of benefits plan issued under Chapter |
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1507. |
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Sec. 1215.003. EXCEPTION. This chapter does not apply to: |
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(1) a plan that provides coverage: |
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(A) only for a specified disease; |
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(B) only for accidental death or dismemberment; |
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(C) 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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(D) as a supplement to a liability insurance |
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policy; |
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(E) only for dental or vision care; |
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(F) only for indemnity for hospital confinement; |
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or |
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(G) only for health care services provided to an |
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enrollee while the enrollee is traveling to, visiting, or residing |
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in a foreign country; |
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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 insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefit coverage so |
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comprehensive that the policy is a health benefit plan as described |
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by Section 1215.002. |
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Sec. 1215.004. OUT-OF-COUNTRY CARE PROHIBITED. A health |
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benefit plan issuer may not issue or offer for sale in this state a |
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health benefit plan that requires an enrollee to travel to a foreign |
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country to receive a particular health care service under the |
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health benefit plan. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2008. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2008, |
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is covered by the law in effect at the time the plan was delivered, |
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issued for delivery, or renewed, and that law is continued in effect |
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for that purpose. |
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SECTION 3. This Act takes effect September 1, 2007. |
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______________________________ |
______________________________ |
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President of the Senate |
Speaker of the House |
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I hereby certify that S.B. No. 1391 passed the Senate on |
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May 4, 2007, by the following vote: Yeas 31, Nays 0; and that the |
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Senate concurred in House amendment on May 25, 2007, by the |
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following vote: Yeas 30, Nays 0. |
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______________________________ |
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Secretary of the Senate |
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I hereby certify that S.B. No. 1391 passed the House, with |
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amendment, on May 23, 2007, by the following vote: Yeas 144, |
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Nays 0, two present not voting. |
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______________________________ |
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Chief Clerk of the House |
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Approved: |
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______________________________ |
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Date |
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______________________________ |
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Governor |