HBA-ATS H.B. 3053 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 3053
By: Reyna, Elvira
Insurance
4/19/1999
Introduced



BACKGROUND AND PURPOSE 

To breastfeed or not to breastfeed is a question faced by many new or
expectant mothers.  Although breastfeeding has suffered from social stigma,
public attitudes toward breastfeeding are changing. This is probably due to
scientific evidence that indicates that breastfeeding protects infants from
infection, prevents allergies in infants, decreases diarrhea in infants,
and decreases infant mortality and infant obesity.  In addition, more
recent research suggests that breast milk provides protection to newborns
from major illnesses such as childhood diabetes (insulin dependent diabetes
mellitus), gastrointestinal diseases, and some types of cancer (lymphomas).
Other studies indicate that mothers who breastfeed have fewer instances of
breast and ovarian cancer.  All of these factors relate to lower health
care costs for women and children. 

A mother who chooses to breastfeed is likely  to be dependent upon help
from health professionals for advice about breastfeeding.  Many of these
health professionals are International Board of Lactation Consultant
Examiners certified lactation consultants who assist mothers with their
breastfeeding questions and concerns and provide breastfeeding-related
products and services. Without insurance coverage, the use of a lactation
consultant may be cost prohibitive for many women. 

H.B. 3053 sets forth that a health benefit plan that provides maternity
benefits must provide coverage for a lactation consultant requested by the
enrollee during pregnancy and for one year after the date of delivery of
the enrollee's child.  Although these benefits may be made subject to a
deductible, copayment, or coinsurance requirement, the deductible,
copayment, or coinsurance is prohibited from exceeding the deductible,
copayment, or coinsurance required by the plan for any other maternity
benefit.  

RULEMAKING AUTHORITY

It is the opinion of the Office of House Bill Analysis that rulemaking
authority is expressly delegated to the commissioner of insurance in
SECTION 1 (Article 21.53Q, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter E, Chapter 21, Insurance Code, by adding
Article 21.53Q, as follows: 

ARTICLE 21.53Q.  COVERAGE FOR SERVICES OF LACTATION CONSULTANT

Sec. 1.  DEFINITIONS.  Defines "enrollee," "health benefit plan," and
"lactation consultant." 

Sec. 2.  SCOPE OF ARTICLE.  (a) Specifies that Article 21.53Q applies only
to a health benefit  plan (plan) that provides benefits for medical or
surgical expenses incurred because of a health condition, accident, or
sickness.  These types of plans include an individual, group, blanket, or
franchise insurance policy or insurance agreement, a group hospital service
contract, and individual or group coverage.  Specifies that these plans are
offered by an insurance company; a group hospital service corporation; a
fraternal benefit society; a stipulated premium insurance company; a
reciprocal exchange; a health maintenance  organization; a multiple
employer welfare arrangement; and an approved nonprofit health corporation. 

(b) Provides that Article 21.53Q does not apply to a plan that provides
coverage only for a specific disease or other limited benefit; only for
accidental death or dismemberment; for wages or payments for a period
during which an employee is absent from work because of sickness or injury;
as a supplement to liability insurance; for credit insurance; only for
dental or vision care; only for hospital expenses; or only for indemnity
for hospital confinement.  Also excluded is a small employer health benefit
plan; a Medicare supplemental policy; workers' compensation insurance
coverage; medical payment insurance coverage issued as part of a motor
vehicle insurance policy; or a long-term care policy. 

Sec. 3.  COVERAGE REQUIRED.  Sets forth that a plan that provides maternity
benefits must provide coverage for a lactation consultant requested by the
enrollee during pregnancy and for one year after the date of delivery of
the enrollee's child.  Authorizes these benefits to be made subject to a
deductible, copayment, or coinsurance requirement.  Prohibits the possible
deductible, copayment, or coinsurance from exceeding the deductible,
copayment, or coinsurance required by the plan for any other maternity
benefit.  

Sec. 4.  RULES.  Authorizes the commissioner of insurance to adopt rules
necessary to administer this article. 

SECTION 2.Effective date: September 1, 1999.
Makes application of this Act prospective for a plan that is delivered,
issued for delivery, or renewed on or after January 1, 2000. 

SECTION 3.  Emergency clause.