Part I.
Texas Department of Insurance
Chapter 26.
Small Employer Health Insurance Regulations
The Commissioner of Insurance adopts amendments to Chapter 26 by amending
§26.14, concerning coverage for minimum inpatient stay in a health care
facility and postdelivery care following the birth of a child and amending
§26.305, concerning coverage of certain tests for detection of prostate
cancer, group coverage of certain students, and access to certain obstetrical
or gynecological care. The amendments are adopted without changes to the proposed
text as published in the December 4, 1998, issue of the
Texas Register
(23 TexReg 12191) and will not be republished.
The amended sections are necessary to implement legislation enacted by
the 75th Legislature and the federal government. During the 75th Legislative
Session, various coverages were added to the benefits that must be provided
by certain health benefit plans in HOUSE BILL 864, SENATE BILL 258, HOUSE
BILL 102 and SENATE BILL 54. If a health benefit plan conditions dependent
coverage for a child 21 years of age or older on the child being a full-time
student at an educational institution, Insurance Code Article 21.24-2, §3
(relating to group coverage of certain students) (HOUSE BILL 864) requires
the plan to cover an entire academic term during which the child begins as
a full-time student and remains enrolled. If a health benefit plan includes
diagnostic medical procedures, Insurance Code Article 21.53F §3 (relating
to coverage of certain tests for detection of prostate cancer) (SENATE BILL
258) requires the plan to provide a diagnostic test for detection of prostate
cancer. If a health benefit plan includes coverage for maternity or childbirth,
Article 21.53F §4 (relating to coverage for minimum inpatient stay in
a health care facility and postdelivery care following the birth of a child)
(HOUSE BILL 102) requires minimum inpatient or postdelivery care following
childbirth. Insurance Code Article 21.53D (relating to access to certain obstetrical
or gynecological care) (SENATE BILL 54) requires certain health benefit plans
to provide a female enrollee the right to select an OB/GYN in addition to
a primary care physician to provide health care services within the scope
of the professional specialty services.
Section 26.14(j) provides that a small employer health benefit plan containing
maternity benefits must include coverage for minimum inpatient stay in a health
care facility and postdelivery care in accordance with Article 21.53F §4.
The mandated benefit requiring minimum in-patient care for maternity and childbirth
coverage includes small employer plans in the definition of health benefit
plan because the minimum inpatient maternity stay is required by federal law
pursuant to the Newborns' and Mothers' Health Protection Act of 1996 (NMHPA),
Pub. L. Number 104-204 Title VI §§601-606. In order to maintain
regulatory authority over health benefit plans in the State of Texas, the
commissioner is required to implement the provisions of the Health Insurance
Portability and Accessibility Act (HIPAA), which was amended to include the
NMHPA.
Section 26.305(l), (m) and (n) provide that large employer health benefit
plans must include benefits for prostate cancer examinations, certain students,
and obstetrical or gynecological care. Insurance Code Articles 21.24-2 §2(b)(2)
(HOUSE BILL 864), 21.53D §2(c)(2) (SENATE BILL 54) and 21.53F §2(b)(2)
(SENATE BILL 258) exclude from the definition of health benefit plan those
plans that are written under Chapter 26 of the Insurance Code. During the
same legislative session in which HOUSE BILL 864, SENATE BILL 54 and SENATE
BILL 258 were passed, however, Chapter 26 was amended by HOUSE BILL 1212 to
add large employer plans, whereas previously it had contained only small employer
plans. A determination has been made that by excluding health benefit plans
under Chapter 26 from Insurance Code Articles 21.24-2 §2(b)(2) (HOUSE
BILL 864), 21.53D §2(c)(2) (SENATE BILL 54) and 21.53F §2(b)(2)
(SENATE BILL 258), the Legislature intended only to exclude small employer
plans from these mandated benefits. The Legislature obviously did not intend
to mandate these coverages only to exclude most plans from compliance but
intended to exempt only small employer plans from coverages of certain tests
for detection of prostate cancer, group coverage of certain students and access
to certain obstetrical or gynecological care.
No comments were received.
Subchapter A. Small Employer Health Insurance Portability and Availability Act Regulations