Bill Text: TX SB756 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to required coverage for obesity under group health benefit plans.
Sponsorship: Partisan Bill (Democrat 1)
Status: (Introduced - Dead) 2017-02-22 - Referred to Business & Commerce [SB756 Detail]
Download: Texas-2017-SB756-Introduced.html
| 85R8019 PMO-D | ||
| By: Menéndez | S.B. No. 756 | |
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| relating to required coverage for obesity under group health | ||
| benefit plans. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle E, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1372 to read as follows: | ||
| CHAPTER 1372. OBESITY | ||
| Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter | ||
| applies only to a group health benefit plan that provides benefits | ||
| for medical or surgical expenses incurred as a result of a health | ||
| condition, accident, or sickness, including a group insurance | ||
| policy, group insurance agreement, group hospital service | ||
| contract, or group evidence of coverage or similar coverage | ||
| document that is offered 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) a multiple employer welfare arrangement that holds | ||
| a certificate of authority under Chapter 846; | ||
| (5) a stipulated premium company operating under | ||
| Chapter 884; or | ||
| (6) a fraternal benefit society operating under | ||
| Chapter 885. | ||
| (b) Notwithstanding any other law, this chapter applies to | ||
| group coverage provided through a small employer health benefit | ||
| plan subject to Chapter 1501, including group coverage provided | ||
| through a health group cooperative under Subchapter B of that | ||
| chapter. | ||
| Sec. 1372.002. CONDITIONAL EXCEPTION. This chapter does | ||
| not apply to a qualified health plan if a determination is made | ||
| under 45 C.F.R. Section 155.170 that: | ||
| (1) this chapter requires the plan to offer benefits | ||
| in addition to the essential health benefits required under 42 | ||
| U.S.C. Section 18022(b); and | ||
| (2) this state is required to defray the cost of the | ||
| benefits mandated under this chapter. | ||
| Sec. 1372.003. REQUIRED COVERAGE FOR OBESITY. (a) A group | ||
| health benefit plan must provide coverage, based on medical | ||
| necessity, for the diagnosis and treatment of obesity. | ||
| (b) Coverage required under Subsection (a) is limited to a | ||
| service, including bariatric surgery and nutritional counseling | ||
| and therapy, or a medication, to the extent the group health benefit | ||
| plan provides pharmacy benefits, ordered by a licensed physician, | ||
| psychiatrist, psychologist, or therapist within the scope of the | ||
| practitioner's license and in accordance with a treatment plan. | ||
| (c) On request from the group health benefit plan issuer, an | ||
| obesity treatment plan must include all elements necessary for the | ||
| issuer to pay a claim under the group health benefit plan, which may | ||
| include a diagnosis, goals, and proposed treatment by type, | ||
| frequency, and duration. | ||
| SECTION 2. Not later than November 1 of each even-numbered | ||
| year, the comptroller of public accounts shall prepare and submit | ||
| to the legislature a biennial report on the human and financial cost | ||
| of obesity in this state. This section expires December 1, 2020. | ||
| SECTION 3. The changes in law made by this Act apply only to | ||
| a group health benefit plan delivered, issued for delivery, or | ||
| renewed on or after January 1, 2018. | ||
| SECTION 4. This Act takes effect September 1, 2017. | ||
