AN ACT

 1-1     relating to coverage under certain health benefit plans of tests

 1-2     for the detection of prostate cancer.

 1-3           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-4           SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is

 1-5     amended by adding Article 21.53F to read as follows:

 1-6           Art. 21.53F.  COVERAGE OF CERTAIN TESTS FOR DETECTION OF

 1-7     PROSTATE CANCER

 1-8           Sec. 1.  DEFINITION.  In this article, "health benefit plan"

 1-9     means a plan described by Section 2 of this article.

1-10           Sec. 2.  SCOPE OF ARTICLE.  (a)  This article applies to a

1-11     health benefit plan that:

1-12                 (1)  provides benefits for medical or surgical expenses

1-13     incurred as a result of a health condition, accident, or sickness,

1-14     including:

1-15                       (A)  an individual, group, blanket, or franchise

1-16     insurance policy or insurance agreement, a group hospital service

1-17     contract, or an individual or group evidence of coverage that is

1-18     offered by:

1-19                             (i)  an insurance company;

1-20                             (ii)  a group hospital service corporation

1-21     operating under Chapter 20 of this code;

1-22                             (iii)  a fraternal benefit society

1-23     operating under Chapter 10 of this code;

 2-1                             (iv)  a stipulated premium insurance

 2-2     company operating under Chapter 22 of this code; or

 2-3                             (v)  a health maintenance organization

 2-4     operating under the Texas Health Maintenance Organization Act

 2-5     (Chapter 20A, Vernon's Texas Insurance Code); and

 2-6                       (B)  to the extent permitted by the Employee

 2-7     Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et

 2-8     seq.), a health benefit plan that is offered by:

 2-9                             (i)  a multiple employer welfare

2-10     arrangement as defined by Section 3, Employee Retirement Income

2-11     Security Act of 1974 (29 U.S.C. Section 1002); or

2-12                             (ii)  another analogous benefit

2-13     arrangement;

2-14                 (2)  is offered by an approved nonprofit health

2-15     corporation that is certified under Section 5.01(a), Medical

2-16     Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and

2-17     that holds a certificate of authority issued by the commissioner

2-18     under Article 21.52F of this code;

2-19                 (3)  is offered by any other entity not licensed under

2-20     this code or another insurance law of this state that contracts

2-21     directly for health care services on a risk-sharing basis,

2-22     including an entity that contracts for health care services on a

2-23     capitation basis; or

2-24                 (4)  notwithstanding Section 172.014, Local Government

2-25     Code, or any other law, provides health and accident coverage

 3-1     through a risk pool created under Chapter 172, Local Government

 3-2     Code.

 3-3           (b)  This article does not apply to:

 3-4                 (1)  a plan that provides coverage:

 3-5                       (A)  only for a specified disease or other

 3-6     limited benefit;

 3-7                       (B)  only for accidental death or dismemberment;

 3-8                       (C)  for wages or payments in lieu of wages for a

 3-9     period during which an employee is absent from work because of

3-10     sickness or injury;

3-11                       (D)  as a supplement to liability insurance; or

3-12                       (E)  only for indemnity for hospital confinement;

3-13                 (2)  a plan written under Chapter 26 of this code;

3-14                 (3)  a Medicare supplemental policy as defined by

3-15     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);

3-16                 (4)  workers' compensation insurance coverage;

3-17                 (5)  medical payment insurance issued as part of a

3-18     motor vehicle insurance policy; or

3-19                 (6)  a long-term care policy, including a nursing home

3-20     fixed indemnity policy, unless the commissioner determines that the

3-21     policy provides benefit coverage so comprehensive that the policy

3-22     is a health benefit plan as described by Subsection (a) of this

3-23     section.

3-24           Sec. 3.  REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE

3-25     DETECTION OF PROSTATE CANCER.  (a)  A health benefit plan that

 4-1     provides benefits for diagnostic medical procedures must provide

 4-2     coverage for each male enrolled in the plan for expenses incurred

 4-3     in conducting an annual medically recognized diagnostic examination

 4-4     for the detection of prostate cancer.

 4-5           (b)  The minimum benefits provided under Subsection (a) of

 4-6     this section must include:

 4-7                 (1)  a physical examination for the detection of

 4-8     prostate cancer; and

 4-9                 (2)  a prostate-specific antigen test used for the

4-10     detection of prostate cancer for each male enrolled in the plan who

4-11     is:

4-12                       (A)  at least 50 years of age and asymptomatic;

4-13     or

4-14                       (B)  at least 40 years of age with a family

4-15     history of prostate cancer or another prostate cancer risk factor.

4-16           Sec. 4.  NOTICE.  Each health benefit plan shall provide

4-17     written notice to each person enrolled in the plan regarding the

4-18     coverage required by this article.  The notice must be provided in

4-19     accordance with rules adopted by the commissioner.

4-20           Sec. 5.  RULES.  The commissioner shall adopt rules as

4-21     necessary to administer this article.

4-22           SECTION 2.  This Act takes effect September 1, 1997, and

4-23     applies only to a health benefit plan that is delivered, issued for

4-24     delivery, or renewed on or after January 1, 1998.  A plan that is

4-25     delivered, issued for delivery, or renewed before January 1, 1998,

 5-1     is governed by the law as it existed immediately before the

 5-2     effective date of this Act, and that law is continued in effect for

 5-3     that purpose.

 5-4           SECTION 3.  The importance of this legislation and the

 5-5     crowded condition of the calendars in both houses create an

 5-6     emergency and an imperative public necessity that the

 5-7     constitutional rule requiring bills to be read on three several

 5-8     days in each house be suspended, and this rule is hereby suspended.

         _______________________________     _______________________________

             President of the Senate              Speaker of the House

               I hereby certify that S.B. No. 258 passed the Senate on

         April 4, 1997, by a viva-voce vote; and that the Senate concurred

         in House amendments on May 28, 1997, by the following vote:

         Yeas 31, Nays 0.

                                             _______________________________

                                                 Secretary of the Senate

               I hereby certify that S.B. No. 258 passed the House, with

         amendments, on May 26, 1997, by a non-record vote.

                                             _______________________________

                                                 Chief Clerk of the House

         Approved:

         _______________________________

                     Date

         _______________________________

                   Governor