By McCall H.B. No. 2093
75R2526 PB-F
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage under certain health benefit plans of tests
1-3 for the detection of prostate cancer.
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 21.53F to read as follows:
1-7 Art. 21.53F. COVERAGE OF CERTAIN TESTS FOR DETECTION OF
1-8 PROSTATE CANCER
1-9 Sec. 1. DEFINITION. In this article, "health benefit plan"
1-10 means a plan that provides benefits for medical or surgical
1-11 expenses incurred as a result of a health condition, accident, or
1-12 sickness and that is offered by any insurance company, group
1-13 hospital service corporation, or health maintenance organization
1-14 that delivers or issues for delivery an individual, group, blanket,
1-15 or franchise insurance policy or insurance agreement, a group
1-16 hospital service contract, or an evidence of coverage, by a
1-17 multiple employer welfare arrangement as defined by Section 3,
1-18 Employee Retirement Income Security Act of 1974 (29 U.S.C. Section
1-19 1002), or by any other analogous benefit arrangement to the extent
1-20 permitted by the Employee Retirement Income Security Act of 1974
1-21 (29 U.S.C. Section 1001 et seq.). The term does not include:
1-22 (1) a plan that provides coverage:
1-23 (A) only for accidental death or dismemberment;
1-24 (B) for wages or payments in lieu of wages for a
2-1 period during which an employee is absent from work because of
2-2 sickness or injury; or
2-3 (C) as a supplement to liability insurance;
2-4 (2) a Medicare supplemental policy as defined by
2-5 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
2-6 (3) workers' compensation insurance coverage;
2-7 (4) medical payment insurance issued as part of a
2-8 motor vehicle insurance policy;
2-9 (5) a plan written under Chapter 26 of this code; or
2-10 (6) a long-term care policy, including a nursing home
2-11 fixed indemnity policy, unless the commissioner determines that the
2-12 policy provides benefit coverage so comprehensive that the policy
2-13 meets the definition of a health benefit plan.
2-14 Sec. 2. REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE
2-15 DETECTION OF PROSTATE CANCER. (a) A health benefit plan that
2-16 provides benefits for diagnostic medical procedures must provide
2-17 coverage for each male enrolled in the plan for expenses incurred
2-18 in conducting an annual medically recognized diagnostic examination
2-19 for the detection of prostate cancer.
2-20 (b) An examination under Subsection (a) of this section must
2-21 include:
2-22 (1) a digital rectal examination; and
2-23 (2) a prostate specific antigen test used for the
2-24 detection of prostate cancer for each male enrolled in the plan who
2-25 is:
2-26 (A) at least 50 years of age and asymptomatic;
2-27 or
3-1 (B) at least 40 years of age with a family
3-2 history of prostate cancer or another prostate cancer risk factor.
3-3 Sec. 3. NOTICE. (a) Each health benefit plan shall provide
3-4 written notice to each person enrolled in the plan regarding the
3-5 coverage required by this article. The notice must be provided in
3-6 accordance with rules adopted by the commissioner.
3-7 (b) The notice required under this section must be
3-8 prominently positioned in any literature or correspondence made
3-9 available or distributed by the health benefit plan.
3-10 Sec. 4. RULES. The commissioner shall adopt rules as
3-11 necessary to administer this article.
3-12 SECTION 2. This Act takes effect September 1, 1997, and
3-13 applies only to a health benefit plan that is delivered, issued for
3-14 delivery, or renewed on or after January 1, 1998. A plan that is
3-15 delivered, issued for delivery, or renewed before January 1, 1998,
3-16 is governed by the law as it existed immediately before the
3-17 effective date of this Act, and that law is continued in effect for
3-18 that purpose.
3-19 SECTION 3. The importance of this legislation and the
3-20 crowded condition of the calendars in both houses create an
3-21 emergency and an imperative public necessity that the
3-22 constitutional rule requiring bills to be read on three several
3-23 days in each house be suspended, and this rule is hereby suspended.