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.