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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 injuries related to |
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certain conduct of a covered individual. |
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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 RELATING TO INJURIES RELATED TO CERTAIN |
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CONDUCT |
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Sec. 1380.001. 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 health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; or |
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(8) an exchange operating under Chapter 942. |
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(b) 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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(c) This chapter applies to a consumer choice of benefits |
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plan issued under Chapter 1507. |
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Sec. 1380.002. CONDITIONAL EXCEPTION. This chapter does |
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not apply to a qualified health plan if a determination is made |
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under 45 C.F.R. Section 155.170 that: |
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(1) this chapter requires the plan to offer benefits |
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in addition to the essential health benefits required under 42 |
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U.S.C. Section 18022(b); and |
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(2) this state is required to defray the cost of the |
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benefits mandated under this chapter. |
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Sec. 1380.003. EXCLUSION OF COVERAGE PROHIBITED. (a) A |
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health benefit plan may not exclude coverage for any emergency or |
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other medical, hospital, or surgical expenses incurred by a covered |
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individual as a result of and related to an injury that is |
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self-inflicted or caused in an attempt to commit suicide, |
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regardless of: |
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(1) the individual's state of mental health; or |
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(2) whether the injury results in the individual's |
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death. |
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(b) Coverage required under this chapter may be subject to |
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deductibles, copayments, coinsurance, or annual or maximum payment |
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limits that are consistent with deductibles, copayments, |
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coinsurance, or annual or maximum payment limits applicable to |
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other similar coverage under the health benefit plan. |
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Sec. 1380.004. RULES. The commissioner shall adopt rules |
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necessary to implement this chapter. |
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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, 2016. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2016, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 3. This Act takes effect September 1, 2015. |