NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 29 (SB 29) relating to Child Support SECTIONS 3, 11, 12, 13 and 14 amend the Family Code
Effective Date of Statute: 9/1/97
Requirements of Statute
These SECTIONS of the bill amend the Family Code and refer to health care coverage. A summary of the changes include (1) defining Medical Support (periodic payment or lump sum payment made under an order to cover medical expense, including health insurance coverage, incurred for the benefit of a child; (2) requiring that if the employee or member is eligible for dependent health coverage, the employer shall automatically enroll the child for the first 31 days after receipt or notice of a medical support order; (3) allowing a notice of medical support order to be included in an order or writ of withholding; (4) requiring an order/notice of medical support to an employer for health insurance coverage is binding on the current or subsequent employer on receipt without regard to the date the order was rendered. The employer shall immediately enroll the child in the health insurance plan regardless of whether the employee is enrolled in the plan; and (5) requiring notice of termination or lapse of insurance coverage - Sections 101.020, 154.184, 154.186, 154.187 and 154.189, Family Code.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Amend procedures to comply.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop and propose rules. Review filings. Develop/revise checklists and other educational materials/ brochures. Take any other necessary action.
Applicable Date of Compliance:
Changes to law do not affect a proceeding under the Family Code pending on 9/1/97 - SECTION 98(b) of SB 29.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 29 - Continued SECTIONS 96 & 98 amends Article 3.96-8, Texas Insurance Code (Relating to Medical Support Orders) is amended
Effective Date of Statute:
Requirements of Statute
Medical Support Orders/Service Area Restrictions Prohibited - An insurer/HMO shall provide coverage for a covered child (subject to a medical support order) who resides outside the insurer/HMO's service area. The coverage provided shall be comparable to that provided to other dependents. "Comparable coverage" may include coverage under which an insurer/HMO uses different procedures for service delivery and health care provider reimbursement. The coverage may NOT be limited to emergency services only. The coverage may NOT include coverage for which the insurer charges a higher premium - Article 3.96-8(a).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agent force). Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Article 20A; (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop and propose rules. Review filings. Develop/revise checklists and other educational materials/ brochures. Take any other necessary action.
Applicable Date of Compliance:
Applies to orders for coverage of a dependent child under a policy or evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 98(f) of SB 29.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 29 - Continued
Effective Date of Statute:
Requirements of Statute
Rules - The commissioner shall adopt rules to define "comparable coverage" in a manner consistent with federal law and that meets requirements to maintain federal Medicaid funding - Article 3.96-8 (c).
Responsibility of and/or Action Needed by Carriers
Monitor development and adoption of rules.
Responsibility of and/or Action Needed by TDI
Develop and propose rules. Take any other necessary action.
Applicable Date of Compliance:
Rules to adopted by 1/1/98 - SECTION 98(e) of SB 29.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 54 (SB 54) relating to Access to Certain Obstetrical or Gynecological Health Care SECTION 1 adds Article 21.53D to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Scope of Article - This article applies to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy/agreement, a group hospital service contract or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F), to the extent permitted by the Employee Retirement Income Security Act, a multiple employer welfare arrangement, or another analogous benefit arrangement, or by any other entity that contracts directly for health care services. This article also applies to coverage provided by a risk pool under Chapter 172, Local Government Code. This article applies to each health benefit plan that requires an enrollee to obtain certain specialty health care services through a referral made by a primary care physician (PCP) or other gatekeeper - Article 21.53D, Sec. 2(a), (b), and (d).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
This bill will currently only affect HMOs since present statutes and rules to not allow health insurance contracts to have PCP or gatekeepers. Rules will be proposed to clarify this.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
This article does NOT apply to a plan that provides coverage only for a specified disease; accidental death or dismemberment; disability income; as a supplement to liability insurance; a plan written under Chapter 26; a Medicare supplemental policy; workers' compensation insurance coverage; medical payment insurance issued as part of a motor vehicle insurance policy; a long term care policy; any health benefit plan that does not provide pregnancy-related benefits or well-woman care benefits - Article 21.53D, Sec. 2(c).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
Access of Female Enrollee to Health Care - Each health benefit plan shall permit a woman who is entitled to coverage under the plan to select, in addition to a PCP, a gynecologist or obstetrician (OB/GYN). This OB/GYN may provide services within the scope of the professional specialty practice of a credentialed specialist in obstetrics or gynecology. This article does not preclude a woman from selecting a family physician, internal medicine physician, or other qualified physician to provide that care - Article 21.53D, Sec. 3(a). The plan shall include a number of credentialed OB/GYNs within the classification of persons that are authorized to provide medical services sufficient to ensure access to the services that fall within the scope of the credentialing. This section does not affect the authority of the plan to establish selection criteria regarding other physicians who provide services through the plan - Article 21.53D, Sec. 3.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, and (b) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop and propose rules. Develop/revise checklists and other educational materials/brochures. Review form filings. Take any other necessary action.
Applicable Date of Compliance:
Applies to a contract/ evidence of coverage delivered, issued or renewed on or after 1/1/98.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
Direct Access to Services of Obstetrician or Gynecologist (OB/GYN) - In addition to other benefits provided by the plan, each plan shall permit a woman who designates an OB/GYN direct access to health care services of the OB/GYN (without a referral by the woman's PCP, prior authorization or precertification). Access to health care services includes, but is not limited to (a) one well-woman exam per year; (b) care related to pregnancy; (c) care for all active gynecological conditions; and (d) diagnosis, treatment, and referral for any disease/condition within the scope of the professional practice of a properly credentialed OB/GYN - Article 21.53D, Sec. 4(a) and (b).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
A health care plan may not impose a copayment or deductible for the OB/GYN services obtained under this Article unless there is a copayment or deductible for access to other health care services provided under the plan - Article 21.53D, Sec. 4(c).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
This articles does not affect the authority of a plan to require the designated OB/GYN to forward any information concerning the medical care of a patient to the patient's PCP. Failure to provide this information may not result in any penalty to the OB/GYN or the patient if the OB/GYN made a reasonable and good-faith effort to provide the information to the PCP - Article 21.53D, Sec. 4(d).
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development and adoption of rules. Revise physician and provider contracts and manuals and submit in accordance with Article 20A.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
A plan may limit a woman's self-referral to one participating OB/GYN for both gynecological and obstetrical care. (This does not limit the right of the woman to select the physician who provides that care) - Article 21.53D, Sec. 4(e).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Article 20A; and (b) any other internal documents.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
A health care plan may not terminate a participating physician as a result of female enrollees' access to participating OB/GYNs under this new law - Article 21.53D, Sec. 4(f).
Responsibility of and/or Action Needed by Carriers
Inform staff. Revise physician and provider contracts & manuals and submit in accordance with Article 20A.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
Notice - Each health benefit plan shall provide to persons covered under the plan a timely written notice (in clear and accurate language) of the choices of the types of physician providers for the direct access to health care services required by this article - Article 21.53D, Sec. 5.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Provide notice as required.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
Rules - The commissioner shall adopt rules as necessary to administer this article - Article 21.53D, Sec. 6.
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents). Monitor development and adoption of rules. Revise or develop as applicable (a) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and physician/provider contracts and submit in accordance with Article 20A; and (b) any other internal documents.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 54 - Continued
Effective Date of Statute:
Requirements of Statute
Administrative Penalty - Any entity that operates a health benefit plan in violation of this article is subject to an administrative penalty under Article 1.10E - Article 21.53D, Sec. 7..
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents).
Responsibility of and/or Action Needed by TDI
Inform staff. Take any other necessary action.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 162 (SB 162) relating to the Prevention and Treatment of Diabetes ARTICLE 2, SECTION 2.01 adds Article 21.53D to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Scope of Article - This article applies to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy/agreement, a group hospital service contract or evidence of coverage this is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO, to the extent permitted by the Employee Retirement Income Security Act of 1974, a multiple employer welfare arrangement or another analogous benefit or coverage provided by a risk pool created under Chapter 172, Local Government Code - Article 21.53D, Sec. 2(a).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 162 - Continued
Effective Date of Statute:
Requirements of Statute
This article does NOT apply to a plan that provides coverage only for a specified disease, accidental death or dismemberment, disability income, as a supplement to liability insurance, dental or vision care, hospital confinement indemnity coverage, a plan written under Chapter 26, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy, or a long term care policy - Article 21.53D, Sec. 2(b).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 162 - Continued
Effective Date of Statute:
Requirements of Statute
Diabetes Care Guidelines - The commissioner, in consultation with the Texas Diabetes Council shall by rule adopt minimum standards for benefits provided to enrollees with diabetes. Each plan shall provide benefits for the minimum standards adopted. Benefits required may NOT be subject to a deductible, coinsurance, or copayment requirement that exceeds the applicable deductible, coinsurance, or copayment applicable to other similar benefits provided under the plan - Article 21.53D, Sec. 3.
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. In consultation with the Texas Diabetes Council, develop and propose rules by 9/1/98 - SECTION 2.02 of SB 162. Review filings. Develop/revise checklists and other educational materials/ brochures. Take any other necessary action.
Applicable Date of Compliance:
Applies to any policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/99 - SECTION 2.03 of SB 162.
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 163 (SB 163) relating Coverage for Supplies and Services Associated with Treatment of Diabetes SECTION 1 adds Article 21.53G to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Scope of Article - This article applies to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy/ agreement, a group hospital service contract or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, a reciprocal exchange, an HMO (including an approved nonprofit health corporation under Article 21.52F), or to the extent permitted by the Employee Retirement Income Security Act of 1974, a multiple employer welfare arrangement - Article 21.53G, Sec. 2(a). This article does NOT apply to a plan that provides coverage only for a specified disease, accidental death or dismemberment, disability income, as a supplement to liability insurance, credit insurance, dental or vision care, hospital confinement indemnity coverage; a small employer plan written under Chapter 26, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy, or a long term care policy - Article 21.53G, Sec. 2(b).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 163 - Continued
Effective Date of Statute:
Requirements of Statute
Required Benefits - A health benefit plan which provides benefits for the treatment of diabetes and associated conditions must provide coverage to each qualified insured (as defined in Article 21.53G, Sec. 1) for: (a) diabetes equipment; (b) diabetes supplies; and (c) diabetes self management training programs - Article 21.53G, Sec. 3.
Responsibility of and/or Action Needed by Carriers
Inform staff. Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop and propose rules. Review filings. Develop/revise checklists and other educational materials/ brochures. Take any other necessary action.
Applicable Date of Compliance:
Applies to any policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 2 of SB 163.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 163 - Continued
Effective Date of Statute:
Requirements of Statute
Diabetes Self Management Training - Diabetes self management training must be provided by a health care practitioner/provider who is licensed/registered/certified in this state to provide appropriate health care services. Self management training includes: (1) training provided to a qualified insured after the initial diagnosis of diabetes in the care and management of that condition (including nutritional counseling and proper use of diabetes equipment and supplies); (2) additional training authorized on the diagnosis of a physician/other health care practitioner of a significant change in the qualified insured's symptoms or condition that requires changes in the insured's self management regime; and (3) periodic or episodic continuing education training when prescribed by an appropriate health care practitioner as warranted by the development of new techniques and treatments for diabetes - Article 21.53G, Sec. 4.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 163 - Continued
Effective Date of Statute:
Requirements of Statute
Effect Of New Treatment Modalities - In addition to the benefits required under Article 21.53G, Secs. 3 and 4, on the approval of the U.S. Food and Drug Administration of new or improved diabetes equipment or diabetes supplies (including insulin or other prescription drugs), each plan must include coverage of the new or improved equipment or supplies if medically necessary and appropriate - Article 21.53G, Sec. 5.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 163 - Continued
Effective Date of Statute:
Requirements of Statute
Limitation - Benefits required under this article may be made subject to a deductible, copayment, or coinsurance requirement; however, they may not exceed the deductible, copayment, or coinsurance required by the plan for treatment of other analogous chronic medical conditions - Article 21.53G, Sec. 6.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 163 - Continued
Effective Date of Statute:
Requirements of Statute
Rules - The commissioner shall adopt rules as necessary for the implementation of this article. The commissioner may consult with the commissioner of public health and other appropriate entities in adopting rules under this section - Article 21.53G, Sec. 7.
Responsibility of and/or Action Needed by Carriers
Monitor development and adoption of rules.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SENATE BILL 172 (SB 172) relating to Childhood Immunizations SECTION 1 adds Article 21.53 F to the Texas Insurance Code
Effective Date of Statute: 9/1/97
Requirements of Statute
Scope of Article - This article applies to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy/agreement, a group hospital service contract or evidence of coverage that is offered by an insurance company, a group hospital service corporation, a fraternal benefit society, a stipulated premium insurance company, an HMO (including an approved nonprofit health corporation under Article 21.52F), or a multiple employer welfare arrangement under Chapter 3, Subchapter I. Additionally, this article applies to health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code - Article 21.53F, Sec. 2(a) and (c).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 172 - Continued
Effective Date of Statute:
Requirements of Statute
This article does NOT apply to a plan that provides coverage only for a specified disease; accidental death or dismemberment; disability income, as a supplement to liability insurance; credit insurance, dental or vision care, hospital confinement indemnity coverage; a small employer health plan under Chapter 26, a Medicare supplemental policy, workers' compensation insurance coverage, medical payment insurance issued as part of a motor vehicle insurance policy; or a long term care policy - Article 21.53F, Sec. 2(b).
Responsibility of and/or Action Needed by Carriers
Responsibility of and/or Action Needed by TDI
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 172 - Continued
Effective Date of Statute:
Requirements of Statute
Required Benefit For Childhood Immunizations - A health benefit plan that provides benefits for a family member of the insured shall provide coverage for each covered child from birth through the date the child is six years of age, for: (1) immunization against diphtheria; haemophilus influenzae type b; hepatitis B; measles; mumps; pertussis; polio; rubella; tetanus; and varicella; and (2) any other immunization that is required by law for the child - Article 21.53F, Sec. 3(a).
Responsibility of and/or Action Needed by Carriers
Inform staff (including agents) Monitor development and adoption of rules. Revise or develop as applicable (a) A&H forms or amendments to bring previously submitted forms into compliance and submit in accordance with Article 3.42; (b) evidence of coverage and other applicable documents given to enrollees, quality assurance plans and submit in accordance with Articles 20A and 21.58A, (c) summary plan descriptions and submit in accordance with 28 TAC 7.1901-7.1910; and (d) any other internal documents.
Responsibility of and/or Action Needed by TDI
Inform staff. Develop and propose rules. Review filings. Develop/revise checklists and other educational materials/ brochures. Take any other necessary action.
Applicable Date of Compliance:
Applies to any policy, contract, evidence of coverage issued, delivered or renewed on or after 1/1/98 - SECTION 2 of SB 172.
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 172 - Continued
Effective Date of Statute:
Requirements of Statute
A child is entitled to benefits under this law if the child, as a result of the child's relationship to an enrollee in the plan, would be entitled to benefits under Article 3.70-2, (K), (L), or (M) - Article 21.53F, Sec. 3(b).
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
NUMBER of BILL. (SECTION/ARTICLE) Statute and Title.
SB 172 - Continued
Effective Date of Statute:
Requirements of Statute
First Dollar Coverage Required - Benefits required by this article may not be made subject to a deductible, copayment, or coinsurance requirement. This section does not prohibit the application of a deductible, copayment, or coinsurance requirement to another service provided at the same time as the immunization - Article 21.53F, Sec. 4.
Responsibility of and/or Action Needed by Carriers
Same as above.
Responsibility of and/or Action Needed by TDI
Same as above.
Applicable Date of Compliance:
* Summary Information is not all inclusive of all requirements of new and/or amended statutes. Summary information is primarily provided for carriers/persons/other entities/HMOs/MEWAs involved with submission of life/health/annuity/HMO/MEWA forms and/or filings for review and/or approval.