SB827 —

AI-generated reading aid from the bill's amendatory text — verify against the official bill.

This bill amends the Texas statutes.

• SUBCHAPTER C. COST-SHARING LIMIT Sec. 1358.101. APPLICABILITY OF SUBCHAPTER. (a) This subchapter 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, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or a small or large employer group contract or similar coverage document 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; (6) a health maintenance organization operating under Chapter 843; (7) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or (8) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844. (b) This subchapter applies to group health coverage made available by a school district in accordance with Section 22.004, Education Code. (c) Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, this subchapter applies to: (1) a basic coverage plan under Chapter 1551; (2) a basic plan under Chapter 1575; (3) a primary care coverage plan under Chapter 1579; and (4) basic coverage under Chapter 1601. (d) Notwithstanding any other law, this subchapter applies to coverage under: (1) the child health plan program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code; and (2) the medical assistance program under Chapter 32, Human Resources Code. Sec. 1358.102. EXCEPTION. This subchapter does not apply to: (1) a health benefit plan that provides coverage: (A) only for a specified disease or for another single benefit; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; (D) as a supplement to a liability insurance policy; (E) for credit insurance; (F) only for dental or vision care; (G) only for hospital expenses; or (H) only for indemnity for hospital confinement; (2) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); (3) medical payment insurance coverage provided under a motor vehicle insurance policy; (4) a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1358.101; (5) health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code; or (6) a workers' compensation insurance policy. Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In this section, "insulin" means a prescription drug that contains insulin and is used to treat diabetes. The term does not include an insulin drug that is administered to a patient intravenously. (b) A health benefit plan may not impose a cost-sharing provision for insulin if the total amount the enrollee is required to pay exceeds $50 for a 30-day supply, regardless of the amount or type of insulin needed to fill the enrollee's prescription.

  amended

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