82R5345 TRH-F     By: Eiland H.B. No. 758       A BILL TO BE ENTITLED   AN ACT   relating to certain limitations in health benefit plans and health   insurance policies.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Section 1201.227, Insurance Code, is amended to   read as follows:          Sec. 1201.227.  POLICY PROVISION: INTOXICANTS AND   NARCOTICS. (a)  Except as provided by Subsection (b), an [An]   individual accident and health insurance policy must contain the   following provision if the policy addresses the subject matter of   the provision:          "Intoxicants and Narcotics: The insurer is not liable for   any loss sustained or contracted in consequence of the insured's   being intoxicated or under the influence of any narcotic unless the   narcotic is administered on the advice of a physician."          (b)  An individual accident and health insurance policy may   not contain the provision described by Subsection (a) if the policy   provides coverage for emergency or other medical, hospital, or   surgical expenses incurred by an insured.          SECTION 2.  Subtitle E, Title 8, Insurance Code, is amended   by adding Chapter 1374 to read as follows:   CHAPTER 1374. BENEFITS RELATING TO INJURIES RELATED TO   INTOXICATION OR USE OF NARCOTICS          Sec. 1374.001.  APPLICABILITY OF CHAPTER. (a) This chapter   applies only to a health benefit plan that provides benefits for   emergency or other medical, hospital, 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 an   individual or group evidence of coverage or similar coverage   document that is offered by:                (1)  an insurance company;                (2)  a group hospital service corporation operating   under Chapter 842 of this code;                (3)  a health maintenance organization operating under   Chapter 843 of this code;                (4)  an approved nonprofit health corporation that   holds a certificate of authority under Chapter 844 of this code;                (5)  a multiple employer welfare arrangement that holds   a certificate of authority under Chapter 846 of this code;                (6)  a stipulated premium insurance company operating   under Chapter 884 of this code;                (7)  a fraternal benefit society operating under   Chapter 885 of this code;                (8)  a Lloyd's plan operating under Chapter 941 of this   code; or                (9)  an exchange operating under Chapter 942 of this   code.          (b)  This chapter applies to:                (1)  a small employer health benefit plan written under   Subchapter B, Chapter 1273, or Chapter 1501;                (2)  a standard health benefit plan offered under   Chapter 1507;                (3)  basic coverage provided under Chapter 1551, a   basic plan provided under Chapter 1575, a primary care coverage   plan provided under Chapter 1579, and basic coverage provided under   Chapter 1601; and                (4)  notwithstanding Section 172.014, Local Government   Code, or any other law, health and accident coverage provided by a   risk pool created under Chapter 172, Local Government Code.          (c)  This chapter does not apply to:                (1)  a health benefit plan that provides coverage:                      (A)  only for benefits for a specified disease or   for another limited benefit other than an accident policy;                      (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; or                      (F)  only for dental or vision care;                (2)  a Medicare supplemental policy as defined by   Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),   as amended;                (3)  a workers' compensation insurance policy;                (4)  medical payment insurance coverage provided under   an automobile insurance policy; or                (5)  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 Subsection (a) of this section.          Sec. 1374.002.  EXCLUSION OF COVERAGE PROHIBITED. (a) A   health benefit plan may not exclude coverage for any emergency or   other medical, hospital, or surgical expenses incurred by an   insured as a result of and related to an injury acquired while the   insured is intoxicated or under the influence of any narcotic,   regardless of whether the intoxicant or narcotic is administered on   the advice of a health care practitioner.          (b)  Coverage required under this chapter may be subject to   deductibles, copayments, coinsurance, or annual or maximum payment   limits that are consistent with deductibles, copayments,   coinsurance, or annual or maximum payment limits applicable to   other similar coverage under the health benefit plan.          Sec. 1374.003.  RULES. The commissioner shall adopt rules   necessary to implement this chapter.          SECTION 3.  The change in law made by this Act applies only   to a health benefit plan that is delivered, issued for delivery, or   renewed on or after January 1, 2012. A health benefit plan that is   delivered, issued for delivery, or renewed before January 1, 2012,   is governed by the law in effect immediately before the effective   date of this Act, and that law is continued in effect for that   purpose.          SECTION 4.  This Act takes effect September 1, 2011.