By Hamric H.B. No. 349
75R2744 DLF-D
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage under certain health benefit plans for care
1-3 after the performance of a mastectomy and certain related
1-4 procedures.
1-5 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-6 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-7 amended by adding Article 21.52G to read as follows:
1-8 Art. 21.52G. COVERAGE FOR HOSPITAL STAYS FOLLOWING
1-9 PERFORMANCE OF A MASTECTOMY AND CERTAIN RELATED PROCEDURES
1-10 Sec. 1. DEFINITION. In this article:
1-11 (1) "Enrollee" means a person entitled to coverage
1-12 under a health benefit plan.
1-13 (2) "Health benefit plan" means a plan described by
1-14 Section 2 of this article.
1-15 Sec. 2. SCOPE OF ARTICLE. (a) This article applies only to
1-16 a health benefit plan that provides benefits for medical or
1-17 surgical expenses incurred as a result of a health condition,
1-18 accident, or sickness, including:
1-19 (1) an individual, group, blanket, or franchise
1-20 insurance policy or insurance agreement, a group hospital service
1-21 contract, or an individual or group evidence of coverage that is
1-22 offered by:
1-23 (A) an insurance company;
1-24 (B) a group hospital service corporation
2-1 operating under Chapter 20 of this code;
2-2 (C) a fraternal benefit society operating under
2-3 Chapter 10 of this code;
2-4 (D) a stipulated premium insurance company
2-5 operating under Chapter 22 of this code; or
2-6 (E) a health maintenance organization operating
2-7 under the Texas Health Maintenance Organization Act (Chapter 20A,
2-8 Vernon's Texas Insurance Code); or
2-9 (2) to the extent permitted by the Employee Retirement
2-10 Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a
2-11 health benefit plan that is offered by:
2-12 (A) a multiple employer welfare arrangement as
2-13 defined by Section 3, Employee Retirement Income Security Act of
2-14 1974 (29 U.S.C. Section 1002); or
2-15 (B) another analogous benefit arrangement.
2-16 (b) This article applies to a health benefit plan that
2-17 provides coverage only for a specific disease or condition or for
2-18 hospitalization.
2-19 (c) This article does not apply to:
2-20 (1) a plan that provides coverage:
2-21 (A) only for accidental death or dismemberment;
2-22 (B) for wages or payments in lieu of wages for a
2-23 period during which an employee is absent from work because of
2-24 sickness or injury; or
2-25 (C) as a supplement to liability insurance;
2-26 (2) a plan written under Chapter 26 of this code;
2-27 (3) a Medicare supplemental policy as defined by
3-1 Section 1882(g)(1), Social Security Act (42 U.S.C. 1395ss);
3-2 (4) workers' compensation insurance coverage;
3-3 (5) medical payment insurance issued as part of a
3-4 motor vehicle insurance policy; or
3-5 (6) a long-term care policy, including a nursing home
3-6 fixed indemnity policy, unless the commissioner determines that the
3-7 policy provides benefit coverage so comprehensive that the policy
3-8 is a health benefit plan as described by Subsection (a) of this
3-9 section.
3-10 Sec. 3. REQUIRED COVERAGE FOR MINIMUM INPATIENT STAY
3-11 FOLLOWING MASTECTOMY OR RELATED PROCEDURE; EXCEPTION. (a) A
3-12 health benefit plan that provides benefits for the treatment of
3-13 breast cancer must include coverage for inpatient care for an
3-14 enrollee for a minimum of:
3-15 (1) 48 hours following a mastectomy; and
3-16 (2) 24 hours following a lymph node dissection for the
3-17 treatment of breast cancer.
3-18 (b) A health benefit plan is not required to provide the
3-19 minimum hours of coverage of inpatient care required under
3-20 Subsection (a) of this section if the enrollee and the enrollee's
3-21 attending physician determine that a shorter period of inpatient
3-22 care is appropriate.
3-23 Sec. 4. PROHIBITIONS. A health benefit plan may not modify
3-24 the terms of coverage because an enrollee requests less than the
3-25 minimum coverage required under Section 2(a) of this article.
3-26 Sec. 5. NOTICE. (a) Each health benefit plan shall provide
3-27 written notice to each enrollee under the plan regarding the
4-1 coverage required by this article. The notice must be provided in
4-2 accordance with rules adopted by the commissioner.
4-3 (b) The notice required under this section must be
4-4 prominently positioned in any literature or correspondence made
4-5 available or distributed by the health benefit plan.
4-6 Sec. 6. RULES. The commissioner shall adopt rules as
4-7 necessary to administer this article.
4-8 SECTION 2. This Act takes effect September 1, 1997, and
4-9 applies only to a health benefit plan that is delivered, issued for
4-10 delivery, or renewed on or after January 1, 1998. A health benefit
4-11 plan that is delivered, issued for delivery, or renewed before
4-12 January 1, 1998, is governed by the law as it existed immediately
4-13 before the effective date of this Act, and that law is continued in
4-14 effect for this purpose.
4-15 SECTION 3. The importance of this legislation and the
4-16 crowded condition of the calendars in both houses create an
4-17 emergency and an imperative public necessity that the
4-18 constitutional rule requiring bills to be read on three several
4-19 days in each house be suspended, and this rule is hereby suspended.