Bill Text: TX SB862 | 2021-2022 | 87th Legislature | Introduced
Bill Title: Relating to health benefit plan coverage for scalp cooling systems, applications, and procedures for certain cancer patients.
Sponsorship: Bipartisan Bill
Status: (Introduced - Dead) 2021-04-26 - Co-author authorized [SB862 Detail]
Download: Texas-2021-SB862-Introduced.html
| 87R4668 RDS-F | ||
| By: Paxton | S.B. No. 862 | |
|
|
||
|
|
||
| relating to health benefit plan coverage for scalp cooling systems, | ||
| applications, and procedures for certain cancer patients. | ||
| BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
| SECTION 1. Subtitle E, Title 8, Insurance Code, is amended | ||
| by adding Chapter 1380 to read as follows: | ||
| CHAPTER 1380. COVERAGE FOR SCALP COOLING FOR CANCER PATIENTS | ||
| Sec. 1380.001. DEFINITIONS. In this chapter: | ||
| (1) "Enrollee" means an individual entitled to | ||
| coverage under a health benefit plan. | ||
| (2) "Scalp cooling" means a system, application, or | ||
| procedure approved by the United States Food and Drug | ||
| Administration for reducing hair loss in an individual undergoing | ||
| chemotherapy treatment. | ||
| Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
| 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 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) 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 chapter 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. 1380.003. 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. 1380.004. COVERAGE REQUIRED. (a) A health benefit | ||
| plan must provide coverage for scalp cooling: | ||
| (1) for an enrollee who is undergoing or has undergone | ||
| medical treatment for cancer; and | ||
| (2) that is determined by the enrollee's treating | ||
| physician to be appropriate for the enrollee in connection with the | ||
| side effects of the medical treatment for cancer. | ||
| (b) An additional premium may not be charged for the | ||
| coverage required by Subsection (a). | ||
| (c) Coverage required under Subsection (a): | ||
| (1) must be provided in a manner determined to be | ||
| appropriate in consultation with the treating physician and the | ||
| enrollee; | ||
| (2) may be subject to annual deductibles, copayments, | ||
| and coinsurance consistent with annual deductibles, copayments, | ||
| and coinsurance required for other coverage under the health | ||
| benefit plan; and | ||
| (3) may not be subject to annual dollar limits. | ||
| Sec. 1380.005. PREAUTHORIZATION. A health benefit plan may | ||
| require prior authorization for scalp cooling in the same manner | ||
| that the health benefit plan requires prior authorization for any | ||
| other health benefit. | ||
| SECTION 2. Chapter 1380, Insurance Code, as added by 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. | ||
