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.