|
|
|
|
AN ACT
|
|
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 [CHAPTER]. (a) |
|
This subchapter [chapter] applies only to: |
|
(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 [chapter] does not apply to an |
|
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 |