SRC-JFA S.B. 217 75(R)    BILL ANALYSIS


Senate Research CenterS.B. 217
By: Zaffirini
Economic Development
3-2-97
As Filed


DIGEST 

Currently, the Insurance Code does not require a health benefit plan to
provide coverage for a breast reconstruction operation following a
mastectomy surgery.  Breast cancer, which affects approximately 11,500
Texas women annually, can be one of the most traumatic experiences a women
ever endures due to a possible removal of a breast.  Studies have shown
that the fear of losing a breast is a leading reason why many women do not
participate in early breast cancer detection programs.  Medical technology
has made it possible to reconstruct a woman's breast following a
mastectomy surgery.  This bill would require a health benefit plan that
provides coverage for a mastectomy to provide coverage for a breast
reconstruction operation to restore or achieve breast symmetry after a
mastectomy operation has been performed.   

PURPOSE

As proposed, S.B. 217 requires a health benefits plan that provides
coverage for a mastectomy to provide coverage for a breast reconstruction
operation incident to the mastectomy.   

RULEMAKING AUTHORITY

Rulemaking authority is granted to the commissioner of the Texas
Department of Insurance under SECTION 1 (Art. 21.53D(3), Insurance Code)
of this bill.   

SECTION BY SECTION ANALYSIS

SECTION 1. Amends Chapter 21E, Insurance Code, by adding Article 21.53D,
as follows: 

Art. 21.53D.  COVERAGE FOR RECONSTRUCTIVE SURGERY AFTER MASTECTOMY

Sec. 1.  DEFINITIONS.  Defines "health benefit plan" and "breast
reconstruction."   

Sec. 2.  COVERAGE REQUIRED.  Requires a health benefits plan that provides
coverage for a mastectomy to provide coverage for breast reconstruction.
Authorizes the coverage to be subject to the same deductible or copayment
applicable to the mastectomy.   

Sec. 3. RULES.  Authorizes the commissioner of insurance to adopt rules to
implement this article.   

SECTION 2. Effective date: September 1, 1997.
  Makes application of this Act prospective to January 1, 1998.  

SECTION 3. Emergency clause.