The Proposal

For the proposal to make sense, a little background on the current law is helpful.

Current law: The current insurance code in Texas requires that group insurance companies offer purchasers (i.e. employers) the option of purchasing speech and hearing coverage. There is no requirement as to when the employer is notified of this coverage or that they be told how much it would cost. The employer has the option of not accepting the coverage or, if they choose to add any coverage for speech and/or hearing services, to negotiate any level of coverage they wish. This assumes that the benefits representative for the employer even realizes that the offer of coverage, which is typically buried in the final paperwork, is even available or that these services are not already covered under a typical policy. This negotiation takes place between the employer and the insurance company; the employee is never offered the option of coverage if the employer chooses not to elect coverage for speech and hearing benefits, and the vast majority of employers do not offer this coverage, even though the change in premiums is minimal.

Proposal Summary: The proposed bill has two parts. This bill would:

• Require insurance companies to notify group plan purchasers (employers) of the offer of coverage at the time of initial quotes and bid the policy with the speech, language and hearing coverage included as an option. This would allow employers the ability to make a more informed choice as to what benefits they wish to provide for their employees. This provision, if passed as written, would apply to covered individuals over the age of 18.
• Require insurance coverage for minors under the age of 18, or those over the age of 18 if eligible as a dependent. The coverage under this provision for speech, language and hearing services would be provided at the same rates as other illness covered under the policy.

Here is the actual text as it was submitted for drafting. PLEASE NOTE: THIS IS NOT THE FINAL BILL. I will post that as soon as the draft is available. (Original statue is in normal text, amendments are underlines, deletions are a strike through.):

A BILL TO BE ENTITLED

AN ACT

relating to group health benefit plan coverage for speech, language, or hearing impairments.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Section 1365.003, Insurance Code, is amended to read as follows:

Sec. 1365.003. OFFER OF COVERAGE REQUIRED. (a) A group health benefit plan issuer shall offer and make available under the plan coverage for the necessary care and treatment of loss or impairment of speech, language, or hearing for those above the age of 18 and who are not otherwise eligible as a dependent.

(b) Coverage required under this section:

(1) may not be less favorable than coverage for physical illness generally under the plan; and

(2) must be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as coverage for physical illness generally under the plan.

(c) Offer of coverage shall be included in all information and quotes offered to group contract holder.

Sec. 1365.004. RIGHT TO REJECT COVERAGE OR SELECT ALTERNATIVE BENEFITS. An offer of coverage required under Section 1365.003 is subject to the right of the group contract holder to reject the coverage or to select an alternative level of benefits that is offered by or negotiated with the group health benefit plan issuer.

Sec. 1365.005. COVERAGE REQUIRED. (a) A group health benefit plan issuer shall provide coverage for the necessary care and treatment of loss or impairment of speech, language, or hearing for those below the age of 18, or above the age of 18 if eligible as a dependent.

(b) Coverage required under this section:

(1) may not be less favorable than coverage for physical illness generally under the plan; and

(2) must be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as coverage for physical illness generally under the plan.

SECTION 2. This Act applies only to an insurance policy or contract or evidence of coverage that is delivered, issued for delivery, or renewed on or after January 1, 2012. An insurance policy or contract or evidence of coverage delivered, issued for delivery, or renewed before January 1, 2012, 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, 2011.