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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for colorectal cancer |
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early detection. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1363.001, Insurance Code, is amended to |
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read as follows: |
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Sec. 1363.001. APPLICABILITY OF CHAPTER. This chapter |
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applies only to a health benefit plan, including a small employer |
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health benefit plan written under Chapter 1501 or coverage that is |
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provided by a health group cooperative under Subchapter B of that |
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chapter, that: |
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(1) provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including: |
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(A) an individual, group, blanket, or franchise |
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insurance policy or insurance agreement, a group hospital service |
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contract, or an individual or group evidence of coverage that is |
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offered by: |
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(i) an insurance company; |
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(ii) a group hospital service corporation |
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operating under Chapter 842; |
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(iii) a fraternal benefit society operating |
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under Chapter 885; |
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(iv) a Lloyd's plan operating under Chapter |
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941; |
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(v) a stipulated premium company operating |
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under Chapter 884; [or] |
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(vi) a health maintenance organization |
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operating under Chapter 843; or |
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(vii) a reciprocal or interinsurance |
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exchange operating under Chapter 942; and |
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(B) to the extent permitted by the Employee |
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
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seq.), a health benefit plan that is offered by: |
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(i) a multiple employer welfare arrangement |
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as defined by Section 3 of that Act; or |
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(ii) another analogous benefit |
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arrangement; |
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(2) is offered by an approved nonprofit health |
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corporation operating under Chapter 844; or |
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(3) provides health and accident coverage through a |
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risk pool created under Chapter 172, Local Government Code, |
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notwithstanding Section 172.014, Local Government Code, or any |
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other law. |
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SECTION 2. Section 1363.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1363.002. EXCEPTION. This chapter does not apply to: |
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(1) a plan that provides coverage: |
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(A) only for a specified disease or other limited |
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benefit; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; [or] |
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(E) only for indemnity for hospital confinement; |
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or |
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(F) only for dental or vision care; |
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(2) [a small employer health benefit plan written |
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under Chapter 1501; |
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[(3)] a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), |
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as amended; |
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(3) a credit-only insurance policy; |
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(4) a workers' compensation insurance policy; |
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(5) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; [or] |
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(6) a limited benefit policy that does not provide |
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coverage for physical examinations or wellness exams; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) [(6)] a long-term care policy, including a nursing |
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home fixed indemnity policy, unless the commissioner determines |
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that the policy provides benefit coverage so comprehensive that the |
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policy is a health benefit plan as described by Section 1363.001. |
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SECTION 3. Section 1363.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1363.003. MINIMUM COVERAGE REQUIRED. (a) A health |
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benefit plan that provides coverage for screening medical |
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procedures must provide to each individual enrolled in the plan who |
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is 45 [50] years of age or older and at normal risk for developing |
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colon cancer coverage for expenses incurred in conducting a |
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medically recognized screening examination for the detection of |
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colorectal cancer. |
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(b) The minimum coverage required under this section must |
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include: |
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(1) all colorectal cancer examinations and laboratory |
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tests specified in the American Cancer Society guidelines for |
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colorectal cancer screening for average-risk individuals as those |
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guidelines existed on January 1, 2021, or a subsequent version of |
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those guidelines adopted by the commissioner by rule, performed at |
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the frequency recommended by those guidelines [a fecal occult |
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blood test performed annually and a flexible sigmoidoscopy |
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performed every five years]; and [or] |
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(2) an initial colonoscopy or other medical test or |
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procedure for colorectal cancer screening and a follow-up |
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colonoscopy if the results of the initial colonoscopy, test, or |
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procedure are abnormal [a colonoscopy performed every 10 years]. |
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(c) For an enrollee in a managed care plan as defined by |
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Section 1451.151, the plan may impose a cost-sharing requirement |
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for coverage described by this section only if the enrollee obtains |
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the covered benefit or service outside the plan's network. |
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SECTION 4. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2022. A health benefit plan that is |
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delivered, issued for delivery, or renewed before January 1, 2022, |
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is governed by the law as it existed immediately before the |
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effective date of this Act, and that law is continued in effect for |
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that purpose. |
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SECTION 5. This Act takes effect September 1, 2021. |