Bill Text: TX HB293 | 2021-2022 | 87th Legislature | Comm Sub


Bill Title: Relating to health benefit coverage for certain fertility preservation services under certain health benefit plans.

Spectrum: Moderate Partisan Bill (Democrat 8-2)

Status: (Introduced) 2021-05-13 - Placed on General State Calendar [HB293 Detail]

Download: Texas-2021-HB293-Comm_Sub.html
  87R15990 JES-F
 
  By: Collier H.B. No. 293
 
  Substitute the following for H.B. No. 293:
 
  By:  Oliverson C.S.H.B. No. 293
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to health benefit coverage for certain fertility
  preservation services under certain health benefit plans.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Chapter 1366, Insurance Code, is amended by
  adding Subchapter C to read as follows:
  SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES
         Sec. 1366.101.  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 an individual or
  group evidence of coverage or similar coverage document that is
  issued in this state by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a health maintenance organization operating under
  Chapter 843;
               (4)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844;
               (5)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (6)  a stipulated premium company operating under
  Chapter 884;
               (7)  a fraternal benefit society operating under
  Chapter 885;
               (8)  a Lloyd's plan operating under Chapter 941; or
               (9)  an exchange operating under Chapter 942.
         (b)  Notwithstanding any other law, this subchapter applies
  to:
               (1)  a small employer health benefit plan subject to
  Chapter 1501, including coverage provided through a health group
  cooperative under Subchapter B of that chapter; and
               (2)  a standard health benefit plan issued under
  Chapter 1507.
         Sec. 1366.102.  EXCEPTIONS. (a)  This subchapter does not
  apply to:
               (1)  a plan that provides coverage:
                     (A)  for wages or payments in lieu of wages for a
  period during which an employee is absent from work because of
  sickness or injury;
                     (B)  as a supplement to a liability insurance
  policy;
                     (C)  for credit insurance;
                     (D)  only for dental or vision care;
                     (E)  only for hospital expenses; or
                     (F)  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(g)(1));
               (3)  a workers' compensation insurance policy;
               (4)  medical payment insurance coverage provided under
  a motor vehicle insurance policy;
               (5)  a long-term care 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 1366.101;
               (6)  Medicaid managed care programs operated under
  Chapter 533, Government Code;
               (7)  Medicaid programs operated under Chapter 32, Human
  Resources Code; or
               (8)  the state child health plan operated under Chapter
  62 or 63, Health and Safety Code.
         (b)  This subchapter does not apply to a qualified health
  plan, as defined by 45 C.F.R. Section 155.20, if a determination is
  made under 45 C.F.R. Section 155.170 that:
               (1)  this subchapter requires the qualified health plan
  to offer benefits in addition to the essential health benefits
  required under 42 U.S.C. Section 18022(b); and
               (2)  this state must make payments to defray the cost of
  the additional benefits mandated by this subchapter.
         (c)  If a determination described by Subsection (b) is made
  as to a qualified health plan, this subchapter does not apply to a
  non-qualified health plan if the non-qualified health plan is
  offered in the same market as the qualified health plan.
         Sec. 1366.103.  REQUIRED COVERAGE. (a) Subject to
  Subsection (b), a health benefit plan must provide coverage for
  fertility preservation services to a covered person who will
  receive a medically necessary treatment, including surgery,
  chemotherapy, and radiation, that the American Society of Clinical
  Oncology or the American Society for Reproductive Medicine has
  established may directly or indirectly cause impaired fertility.
         (b)  The fertility preservation services described by
  Subsection (a) must be standard procedures to preserve fertility
  consistent with established medical practices or professional
  guidelines published by the American Society of Clinical Oncology
  or the American Society for Reproductive Medicine.
         SECTION 2.  This Act applies only to a health benefit plan
  that is delivered, issued for delivery, or renewed on or after
  January 1, 2022.
         SECTION 3.  This Act takes effect September 1, 2021.
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