RS C.S.H.B. 262 75(R)BILL ANALYSIS

INSURANCE
C.S.H.B. 262
By: Van de Putte
4-17-97
Committee Report (Substituted)

BACKGROUND
Breast cancer, which affects approximately 11,500 Texas women annually,
can be one of the most traumatic experiences a women ever endures.  For
those women who live through the disease, horrible scaring and emptiness
often replace what had been a fundamental part of their identities as
women, as whole human beings.  In fact studies show that fear of losing a
breast is a leading reason why many women do not participate in early
breast cancer detection programs.  Today's technology has made it possible
to reconstruct a woman's breast following a mastectomy surgery, to proved
her with a normal appearance.  Unfortunately, state law fails to require
adequate insurance coverage for women to receive reconstructive surgery,
to achieve a normal symmetrical appearance, following a mastectomy
surgery. 

PURPOSE
As proposed C.S.H.B. 262 will require health benefit plans which provide
coverage for a mastectomy surgery to also provide coverage for surgery to
reconstruct both the affected and nonaffected breasts to achieve a normal
symmetrical appearance. 

RULEMAKING AUTHORITY

It is the opinion of the committee that there is additional rule-making
authority in this bill. 
SECTION 1 of bill (Sec. 5. Article 21.53D, Insurance Code).

SECTION BY SECTION ANALYSIS

SECTION 1.  Amends Subchapter E, Chapter 21, of the Insurance Code by
adding Article 21.53D. 

ARTICLE 21.53D.  COVERAGE FOR RECONSTRUCTIVE SURGERY AFTER MASTECTOMY.

Sec. 1. DEFINITION. Makes reference to "health benefit plan" which is
further defined in Section 2 of this Article.  Also defines "Breast
reconstruction." 

Sec. 2. SCOPE OF ARTICLE. (a) Defines a health benefit plan as any health
insurance plan regulatable by the State of Texas including Section 5.01(a)
of the Medical Practice Act nonprofit health corporations. 

(b) Excludes plans for specific disease coverage, accidental death or
dismemberment, wage recovery insurance, or supplemental liability
insurance coverage, medicare, workers compensation, motor vehicle
insurance medical payments, and a long-term care health insurance policy. 

Sec. 3.  COVERAGE REQUIRED.  Any health benefit plan that provides
coverage for mastectomy must provide coverage for breast reconstruction
with the same deductible and co-payment applicable to mastectomy.  


Sec.  4.  PROHIBITION.  Prohibits a health benefit plan from offering
incentives against reconstruction following the mastectomy surgery. 

Sec. 5.  RULES.  The Commissioner of Insurance may adopt rules to
implement this article. 
 
SECTION 2.  EFFECTIVE DATE.  This Article takes effect September 1, 1997,
and applies to a health benefit plan delivered, issued for delivery, or
renewed on or after January 1, 1998. 

SECTION 3.  EMERGENCY CLAUSE.  

COMPARISON OF H.B. 262 AND C.S.H.B. 262.
C.S.H.B. 262 updates the definitions of "health benefit plan" by including
nonprofit health corporations currently regulated under Section 501(a) of
the Medical Practice Act.  Additionally, the substitute prohibits
financial incentives to discourage reconstructive surgery.