Bill Text: TX SB959 | 2019-2020 | 86th Legislature | Introduced
Bill Title: Relating to health benefit coverage for certain fertility preservation services under certain health benefit plans.
Spectrum: Partisan Bill (Democrat 1-0)
Status: (Introduced - Dead) 2019-03-01 - Referred to Business & Commerce [SB959 Detail]
Download: Texas-2019-SB959-Introduced.html
86R6879 PMO-F | ||
By: Menéndez | S.B. No. 959 |
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relating to health benefit coverage for certain fertility | ||
preservation services under certain health benefit plans. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Chapter 1366, Insurance Code, is amended by | ||
adding Subchapter C to read as follows: | ||
SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES | ||
Sec. 1366.101. APPLICABILITY OF SUBCHAPTER. (a) This | ||
subchapter 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 | ||
issued in this state 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 subchapter 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; | ||
(2) a standard health benefit plan issued under | ||
Chapter 1507; | ||
(3) a basic coverage plan under Chapter 1551; | ||
(4) a basic plan under Chapter 1575; | ||
(5) a primary care coverage plan under Chapter 1579; | ||
(6) a plan providing basic coverage under Chapter | ||
1601; | ||
(7) health benefits provided by or through a church | ||
benefits board under Subchapter I, Chapter 22, Business | ||
Organizations Code; | ||
(8) group health coverage made available by a school | ||
district in accordance with Section 22.004, Education Code; | ||
(9) the state Medicaid program, including the Medicaid | ||
managed care program operated under Chapter 533, Government Code; | ||
(10) the child health plan program under Chapter 62, | ||
Health and Safety Code; | ||
(11) a regional or local health care program operated | ||
under Section 75.104, Health and Safety Code; | ||
(12) a self-funded health benefit plan sponsored by a | ||
professional employer organization under Chapter 91, Labor Code; | ||
(13) county employee group health benefits provided | ||
under Chapter 157, Local Government Code; and | ||
(14) health and accident coverage provided by a risk | ||
pool created under Chapter 172, Local Government Code. | ||
Sec. 1366.102. EXCEPTIONS. This subchapter does not apply | ||
to: | ||
(1) a plan that provides coverage: | ||
(A) for wages or payments in lieu of wages for a | ||
period during which an employee is absent from work because of | ||
sickness or injury; | ||
(B) as a supplement to a liability insurance | ||
policy; | ||
(C) for credit insurance; | ||
(D) only for dental or vision care; | ||
(E) only for hospital expenses; or | ||
(F) only for indemnity for hospital confinement; | ||
(2) a Medicare supplemental policy as defined by | ||
Section 1882(g)(1), Social Security Act (42 U.S.C. Section | ||
1395ss(g)(1)); | ||
(3) a workers' compensation insurance policy; | ||
(4) medical payment insurance coverage provided under | ||
a motor vehicle insurance policy; or | ||
(5) 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 1366.001. | ||
Sec. 1366.103. REQUIRED COVERAGE. (a) Subject to | ||
Subsection (b), a health benefit plan must provide coverage for | ||
fertility preservation services to a covered person who will | ||
receive a medically necessary treatment, including surgery, | ||
chemotherapy, and radiation, that the American Society of Clinical | ||
Oncology or the American Society for Reproductive Medicine has | ||
established may directly or indirectly cause impaired fertility. | ||
(b) The fertility preservation services described by | ||
Subsection (a) must be standard procedures to preserve fertility | ||
consistent with established medical practices or professional | ||
guidelines published by the American Society of Clinical Oncology | ||
or the American Society for Reproductive Medicine. | ||
SECTION 2. This Act applies only to a health benefit plan | ||
that is delivered, issued for delivery, or renewed on or after | ||
January 1, 2020. | ||
SECTION 3. This Act takes effect September 1, 2019. |