HBA-JRA H.B. 141 76(R)    BILL ANALYSIS


Office of House Bill AnalysisH.B. 141
By: Reyna, Arthur
Insurance
2/3/1999
Introduced



BACKGROUND AND PURPOSE 

Currently a health benefit plan is not required to provide vision or
medical eye care services or procedures.  H.B. 141 provides that certain
health benefit plans must cover the diagnosis and treatment of deficient
vision including consultation, examination, corrective lenses, and
corrective surgery. 

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 (Sections 3 and 7, Article 21.53X, Insurance Code) of this bill. 

SECTION BY SECTION ANALYSIS

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

Article. 21.53X.  COVERAGE FOR SIGHT-CORRECTIVE PROCEDURES

Sec. 1.  DEFINITIONS.  Defines "enrollee" and "health benefit plan."

Sec. 2.  SCOPE OF ARTICLE.  (a)  Specifies that this article applies only
to a health benefit plan that provides benefits for medical or surgical
expenses incurred as a result of a health condition, accident, or sickness
(lists examples of such plans), or one that is offered by an approved
nonprofit health corporation certified under Section 5.01(a), Medical
Practice Act (Article 4495b, V.T.C.S. (Certification of Certain
Organizations)), that holds a certificate of authority from the
commissioner of insurance (commissioner). 

(b)  Specifies that this article does not apply to:  a plan that provides
only certain limited coverages, a small employer health benefit plan, 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. 

Sec. 3.  COVERAGE REQUIRED.  Provides that a health benefit plan must
provide coverage for the diagnosis and treatment of deficient vision
including consultation, examination, corrective lenses, corrective surgery,
and other measures determined by the commissioner, by rule. 

Sec. 4.  DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS. Prohibits
requiring a deductible, coinsurance, or copayment for these benefits in
excess of the requirements applicable to similar benefits provided under
the health benefit plan. 

Sec. 5.  LIMITATIONS.  Provides that a health benefit plan must provide
coverage for at least one pair of corrective lenses each year.  Prohibits
any limitation adopted by the health benefit plan from restricting the
number of visits to an eye care provider. 

Sec. 6.  NOTICE.  Provides that each health benefit plan must provide each
enrollee with  written notice regarding the coverage required by this
article. 

Sec. 7.  RULES.  Requires the commissioner to adopt rules as necessary to
administer this article. 

SECTION 2.  Effective date: September 1, 1999.
            Makes application of this Act prospective.


SECTION 3.  Emergency clause.