HBA-ATS S.B. 288 76(R) BILL ANALYSIS Office of House Bill AnalysisS.B. 288 By: Carona Insurance 5/10/1999 Engrossed BACKGROUND AND PURPOSE Texas law does not require health benefit plans to cover the treatment of a child for congenital developmental defects or diseases. However, policies that provide maternity or dependent coverage must provide automatic coverage to a newborn child for congenital defects or abnormalities for the initial 31 days. S.B. 288 provides that a health benefit plan that provides benefits to a child who is younger than 18 years of age must define reconstructive surgery for craniofacial abnormalities to mean surgery to improve the function of, or to attempt to create a normal appearance of, an abnormal structure caused by congenital defects, developmental deformities, trauma, tumors, infections, or disease. 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 21.53W, Insurance Code) of this bill. SECTION BY SECTION ANALYSIS SECTION 1. Amends Subchapter E, Chapter 21, Insurance Code, by adding Article 21.53W, as follows: ARTICLE 21.53W. COVERAGE FOR CRANIOFACIAL ABNORMALITIES Sec. 1. DEFINITIONS. Defines "enrollee" and "health benefit plan." Sec. 2. SCOPE OF ARTICLE. (a) Specifies that Article 21.53W 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; any other entity that contracts directly for health care services on a risk-sharing basis; another analogous benefit arrangement; and an approved nonprofit health corporation. (b) Provides that Article 21.53W 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. Provides that a plan that provides benefits to a child who is younger than 18 years of age must define reconstructive surgery for craniofacial abnormalities to mean surgery to improve the function of, or to attempt to create a normal appearance of, an abnormal structure caused by congenital defects, developmental deformities, trauma, tumors, infections, or disease. Sec. 4. RULES. Requires the commissioner of insurance to adopt rules as necessary to administer this article. SECTION 2. Effective date: September 1, 1999. Makes application of this Act prospective, beginning January 1, 2000. SECTION 3. Emergency clause.