Bill Text: TX SB1028 | 2021-2022 | 87th Legislature | Enrolled


Bill Title: Relating to health benefit plan coverage for colorectal cancer early detection.

Spectrum: Slight Partisan Bill (Democrat 11-6)

Status: (Passed) 2021-06-04 - Effective on 9/1/21 [SB1028 Detail]

Download: Texas-2021-SB1028-Enrolled.html
 
 
  S.B. No. 1028
 
 
 
 
AN ACT
  relating to health benefit plan coverage for colorectal cancer
  early detection.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 1363.001, Insurance Code, is amended to
  read as follows:
         Sec. 1363.001.  APPLICABILITY OF CHAPTER. This chapter
  applies only to a health benefit plan, including a small employer
  health benefit plan written under Chapter 1501 or coverage that is
  provided by a health group cooperative under Subchapter B of that
  chapter, that:
               (1)  provides benefits for medical or surgical expenses
  incurred as a result of a health condition, accident, or sickness,
  including:
                     (A)  an individual, group, blanket, or franchise
  insurance policy or insurance agreement, a group hospital service
  contract, or an individual or group evidence of coverage that is
  offered by:
                           (i)  an insurance company;
                           (ii)  a group hospital service corporation
  operating under Chapter 842;
                           (iii)  a fraternal benefit society operating
  under Chapter 885;
                           (iv)  a Lloyd's plan operating under Chapter
  941;
                           (v)  a stipulated premium company operating
  under Chapter 884; [or]
                           (vi)  a health maintenance organization
  operating under Chapter 843; or
                           (vii)  a reciprocal or interinsurance
  exchange operating under Chapter 942; and
                     (B)  to the extent permitted by the Employee
  Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
  seq.), a health benefit plan that is offered by:
                           (i)  a multiple employer welfare arrangement
  as defined by Section 3 of that Act; or
                           (ii)  another analogous benefit
  arrangement;
               (2)  is offered by an approved nonprofit health
  corporation operating under Chapter 844; or
               (3)  provides health and accident coverage through a
  risk pool created under Chapter 172, Local Government Code,
  notwithstanding Section 172.014, Local Government Code, or any
  other law.
         SECTION 2.  Section 1363.002, Insurance Code, is amended to
  read as follows:
         Sec. 1363.002.  EXCEPTION. This chapter does not apply to:
               (1)  a plan that provides coverage:
                     (A)  only for a specified disease or other limited
  benefit;
                     (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; [or]
                     (E)  only for indemnity for hospital confinement;
  or
                     (F)  only for dental or vision care;
               (2)  [a small employer health benefit plan written
  under Chapter 1501;
               [(3)] a Medicare supplemental policy as defined by
  Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
  as amended;
               (3)  a credit-only insurance policy;
               (4)  a workers' compensation insurance policy;
               (5)  medical payment insurance coverage provided under
  a motor vehicle insurance policy; [or]
               (6)  a limited benefit policy that does not provide
  coverage for physical examinations or wellness exams;
               (7)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846; or
               (8) [(6)]  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 1363.001.
         SECTION 3.  Section 1363.003, Insurance Code, is amended to
  read as follows:
         Sec. 1363.003.  MINIMUM COVERAGE REQUIRED. (a) A health
  benefit plan that provides coverage for screening medical
  procedures must provide to each individual enrolled in the plan who
  is 45 [50] years of age or older and at normal risk for developing
  colon cancer coverage for expenses incurred in conducting a
  medically recognized screening examination for the detection of
  colorectal cancer.
         (b)  The minimum coverage required under this section must
  include:
               (1)  all colorectal cancer examinations, preventive
  services, and laboratory tests assigned a grade of "A" or "B" by the
  United States Preventive Services Task Force for average-risk
  individuals, including the services that may be assigned a grade of
  "A" or "B" in the future [a fecal occult blood test performed
  annually and a flexible sigmoidoscopy performed every five years];
  and [or]
               (2)  an initial colonoscopy or other medical test or
  procedure for colorectal cancer screening and a follow-up
  colonoscopy if the results of the initial colonoscopy, test, or
  procedure are abnormal [a colonoscopy performed every 10 years].
         (c)  For an enrollee in a managed care plan as defined by
  Section 1451.151, the plan may impose a cost-sharing requirement
  for coverage described by this section only if the enrollee obtains
  the covered benefit or service outside the plan's network.
         SECTION 4.  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, 2022. A health benefit plan that is
  delivered, issued for delivery, or renewed before January 1, 2022,
  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 5.  This Act takes effect September 1, 2021.
 
 
 
 
 
  ______________________________ ______________________________
     President of the Senate Speaker of the House     
 
         I hereby certify that S.B. No. 1028 passed the Senate on
  April 23, 2021, by the following vote:  Yeas 30, Nays 1.
 
 
  ______________________________
  Secretary of the Senate    
 
         I hereby certify that S.B. No. 1028 passed the House on
  May 18, 2021, by the following vote:  Yeas 121, Nays 16, two
  present not voting.
 
 
  ______________________________
  Chief Clerk of the House   
 
 
 
  Approved:
 
  ______________________________ 
              Date
 
 
  ______________________________ 
            Governor
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