Bill Text: TX SB1028 | 2021-2022 | 87th Legislature | Engrossed
NOTE: There are more recent revisions of this legislation. Read Latest Draft
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-Engrossed.html
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-Engrossed.html
By: Huffman, et al. | S.B. No. 1028 |
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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; [ |
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(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; [ |
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(E) only for indemnity for hospital confinement; | ||
or | ||
(F) only for dental or vision care; | ||
(2) [ |
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[ |
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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; [ |
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(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) [ |
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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 [ |
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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 [ |
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and [ |
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(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 [ |
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(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. |