By: Ellis, et al. S.B. No. 258
A BILL TO BE ENTITLED
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; or
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.
2-24 (b) This article does not apply to:
2-25 (1) a plan that provides coverage:
3-1 (A) only for a specified disease;
3-2 (B) only for accidental death or dismemberment;
3-3 (C) for wages or payments in lieu of wages for a
3-4 period during which an employee is absent from work because of
3-5 sickness or injury; or
3-6 (D) as a supplement to liability insurance;
3-7 (2) a plan written under Chapter 26 of this code;
3-8 (3) a Medicare supplemental policy as defined by
3-9 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
3-10 (4) workers' compensation insurance coverage;
3-11 (5) medical payment insurance issued as part of a
3-12 motor vehicle insurance policy; or
3-13 (6) a long-term care policy, including a nursing home
3-14 fixed indemnity policy, unless the commissioner determines that the
3-15 policy provides benefit coverage so comprehensive that the policy
3-16 is a health benefit plan as described by Subsection (a) of this
3-17 section.
3-18 Sec. 3. REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE
3-19 DETECTION OF PROSTATE CANCER. (a) A health benefit plan that
3-20 provides benefits for diagnostic medical procedures must provide
3-21 coverage for each male enrolled in the plan for expenses incurred
3-22 in conducting an annual medically recognized diagnostic examination
3-23 for the detection of prostate cancer.
3-24 (b) The minimum benefits provided under Subsection (a) of
3-25 this section must include:
4-1 (1) a physical examination for the detection of
4-2 prostate cancer; and
4-3 (2) a prostate-specific antigen test used for the
4-4 detection of prostate cancer for each male enrolled in the plan who
4-5 is:
4-6 (A) at least 50 years of age and asymptomatic;
4-7 or
4-8 (B) at least 40 years of age with a family
4-9 history of prostate cancer or another prostate cancer risk factor.
4-10 Sec. 4. NOTICE. Each health benefit plan shall provide
4-11 written notice to each person enrolled in the plan regarding the
4-12 coverage required by this article. The notice must be provided in
4-13 accordance with rules adopted by the commissioner.
4-14 Sec. 5. RULES. The commissioner shall adopt rules as
4-15 necessary to administer this article.
4-16 SECTION 2. This Act takes effect September 1, 1997, and
4-17 applies only to a health benefit plan that is delivered, issued for
4-18 delivery, or renewed on or after January 1, 1998. A plan that is
4-19 delivered, issued for delivery, or renewed before January 1, 1998,
4-20 is governed by the law as it existed immediately before the
4-21 effective date of this Act, and that law is continued in effect for
4-22 that purpose.
4-23 SECTION 3. The importance of this legislation and the
4-24 crowded condition of the calendars in both houses create an
4-25 emergency and an imperative public necessity that the
5-1 constitutional rule requiring bills to be read on three several
5-2 days in each house be suspended, and this rule is hereby suspended.