88R2521 CJD-F
	By: Buckley	H.B. No. 1322

	A BILL TO BE ENTITLED
	AN ACT
	relating to coordination of vision and eye care benefits under
	certain insurance policies and vision plans.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
	SECTION 1.  Chapter 1203, Insurance Code, is amended by
	adding Subchapter C to read as follows:
	SUBCHAPTER C. VISION AND EYE CARE BENEFITS
	Sec. 1203.101.  DEFINITIONS. In this subchapter:
	(1)  "Benefit plan" means an insurance policy, vision
	benefit plan, or vision discount plan described by Section
	1203.102.
	(2)  "Benefit plan provider" means an insurer or other
	person or entity described by Section 1203.102 that issues or
	provides a benefit plan.
	(3)  "Eye care expenses" means expenses related to
	vision or medical eye care services, procedures, or products.
	Sec. 1203.102.  APPLICABILITY OF SUBCHAPTER. This
	subchapter applies only to an insurance policy, vision benefit
	plan, or vision discount plan that provides or arranges for
	benefits for vision or medical eye care services, procedures, or
	products, including an individual, group, blanket, or franchise
	insurance policy or insurance agreement, a group hospital service
	contract, a vision benefit plan, or a vision discount plan offered
	by:
	(1)  an insurance company;
	(2)  a group hospital service corporation operating
	under Chapter 842;
	(3)  a stipulated premium company operating under
	Chapter 884;
	(4)  a fraternal benefit society operating under
	Chapter 885;
	(5)  a Lloyd's plan operating under Chapter 941;
	(6)  an exchange operating under Chapter 942; or
	(7)  a person or entity that provides a vision benefit
	or vision discount plan.
	Sec. 1203.103.  COORDINATION OF BENEFITS BETWEEN MULTIPLE
	PLANS.  (a)  This section applies if a benefit plan enrollee is
	covered by at least two different benefit plans that provide
	benefits for eye care expenses.
	(b)  The benefit plan provider to whom a claim for
	reimbursement for eye care expenses is initially submitted shall
	reimburse for all eye care expenses covered under the plan up to the
	full amount of any coverage limit applicable to the covered eye care
	expenses.
	(c)  A benefit plan provider to whom a claim for
	reimbursement for eye care expenses is subsequently submitted shall
	reimburse for all eye care expenses covered under the plan that are
	not reimbursed by a benefit plan provider to whom a claim for
	reimbursement was previously submitted.
	(d)  Each benefit plan provider shall provide a summary of
	eye care expenses accepted and denied under the plan to the enrollee
	and the practitioner who provided the eye care services.  The
	summary must be accessible online to the enrollee and the
	practitioner.
	Sec. 1203.104.  CERTAIN COORDINATION OF BENEFITS PROVISIONS
	PROHIBITED.  A benefit plan may not be delivered, issued for
	delivery, or renewed in this state if:
	(1)  a provision of the plan excludes or reduces the
	payment of benefits for eye care expenses to or on behalf of an
	enrollee;
	(2)  the reason for the exclusion or reduction is that
	eye care benefits are payable or have been paid to or on behalf of
	the enrollee under another benefit plan; and
	(3)  the exclusion or reduction would apply before the
	full amount of the eye care expenses incurred by the enrollee and
	covered by both plans have been paid or reimbursed or the full
	amount of the applicable coverage limit of the plan containing the
	exclusion or reduction is reached.
	Sec. 1203.105.  CERTAIN COORDINATION OF BENEFITS PROVISIONS
	VOID. A provision of a benefit plan that violates this subchapter
	is void.
	SECTION 2.  The change in law made by this Act applies only
	to an insurance policy, vision benefit plan, or vision discount
	plan that is delivered, issued for delivery, or renewed on or after
	January 1, 2024.  A policy or plan delivered, issued for delivery,
	or renewed before January 1, 2024, is governed by the law as it
	existed immediately before the effective date of this Act, and that
	law is continued in effect for that purpose.
	SECTION 3.  This Act takes effect September 1, 2023.