Bill Text: TX SB756 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to required coverage for obesity under group health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
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. |