| H.B. No. 3024 | ||
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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; EXCEPTION. (a) | ||
| This subchapter applies only to an insurance policy that provides | ||
| benefits for dental expenses, including, except as provided by | ||
| Subsection (b), 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. | ||
| (b) This subchapter does not apply to a separate dental | ||
| policy that exclusively provides a non-coordinated, fixed | ||
| indemnity benefit, regardless of expenses incurred paid directly to | ||
| the policyholder or to the provider under an assignment of benefits | ||
| provision. | ||
| Sec. 1203.052. COORDINATION OF BENEFITS BETWEEN PRIMARY AND | ||
| SECONDARY INSURERS. (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 any policy limit | ||
| applicable to the covered dental expenses. | ||
| (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), not to exceed the policy limit of | ||
| the secondary policy. | ||
| 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. | ||
| ______________________________ | ______________________________ | |
| President of the Senate | Speaker of the House | |
| I certify that H.B. No. 3024 was passed by the House on May | ||
| 12, 2015, by the following vote: Yeas 115, Nays 26, 3 present, not | ||
| voting. | ||
| ______________________________ | ||
| Chief Clerk of the House | ||
| I certify that H.B. No. 3024 was passed by the Senate on May | ||
| 22, 2015, by the following vote: Yeas 26, Nays 5. | ||
| ______________________________ | ||
| Secretary of the Senate | ||
| APPROVED: _____________________ | ||
| Date | ||
| _____________________ | ||
| Governor | ||