By Van de Putte H.B. No. 262 75R1918 SAW-D A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to coverage under certain health benefit plans for 1-3 reconstructive surgery incident to a mastectomy. 1-4 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-5 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-6 amended by adding Article 21.53D to read as follows: 1-7 Art. 21.53D. COVERAGE FOR RECONSTRUCTIVE SURGERY AFTER 1-8 MASTECTOMY 1-9 Sec. 1. DEFINITIONS. In this article: 1-10 (1) "Health benefit plan" means a plan that provides 1-11 benefits for medical or surgical expenses incurred as a result of a 1-12 health condition, accident, or sickness and that is offered by any 1-13 insurance company, group hospital service corporation, or health 1-14 maintenance organization that delivers or issues for delivery an 1-15 individual, group, blanket, or franchise insurance policy or 1-16 insurance agreement, a group hospital service contract, or an 1-17 evidence of coverage, or, to the extent permitted by the Employee 1-18 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 1-19 seq.), by a multiple employer welfare arrangement as defined by 1-20 Section 3, Employee Retirement Income Security Act of 1974 (29 1-21 U.S.C. Section 1002), or any other analogous benefit arrangement. 1-22 The term does not include: 1-23 (A) a plan that provides coverage: 1-24 (i) only for a specified disease; 2-1 (ii) only for accidental death or 2-2 dismemberment; 2-3 (iii) for wages or payments in lieu of 2-4 wages for a period during which an employee is absent from work 2-5 because of sickness or injury; or 2-6 (iv) as a supplement to liability 2-7 insurance; 2-8 (B) a plan written under Chapter 26 of this 2-9 code; 2-10 (C) a Medicare supplemental policy as defined by 2-11 Section 1882(g)(1), Social Security Act (42 U.S.C. 1395ss); 2-12 (D) workers' compensation insurance coverage; 2-13 (E) medical payment insurance issued as part of 2-14 a motor vehicle insurance policy; or 2-15 (F) a long-term care policy, including a nursing 2-16 home fixed indemnity policy, unless the commissioner determines 2-17 that the policy provides benefit coverage so comprehensive that the 2-18 policy meets the definition of a health benefit plan. 2-19 (2) "Breast reconstruction" means reconstruction of a 2-20 breast incident to mastectomy to restore or achieve breast 2-21 symmetry. The term includes surgical reconstruction of a breast on 2-22 which mastectomy surgery has been performed and surgical 2-23 reconstruction of a breast on which mastectomy surgery has not been 2-24 performed. 2-25 Sec. 2. COVERAGE REQUIRED. A health benefits plan that 2-26 provides coverage for mastectomy must provide coverage for breast 2-27 reconstruction. The coverage may be subject to the same deductible 3-1 or copayment applicable to mastectomy. 3-2 Sec. 3. RULES. The commissioner may adopt rules to 3-3 implement this article. 3-4 SECTION 2. This Act takes effect September 1, 1997, and 3-5 applies only to a health benefit plan that is delivered, issued for 3-6 delivery, or renewed on or after January 1, 1998. A health benefit 3-7 plan that is delivered, issued for delivery, or renewed before 3-8 January 1, 1998, is governed by the law as it existed immediately 3-9 before the effective date of this Act, and that law is continued in 3-10 effect for this purpose. 3-11 SECTION 3. The importance of this legislation and the 3-12 crowded condition of the calendars in both houses create an 3-13 emergency and an imperative public necessity that the 3-14 constitutional rule requiring bills to be read on three several 3-15 days in each house be suspended, and this rule is hereby suspended.