1-1 By: Ellis, Madla S.B. No. 258 1-2 (In the Senate - Filed January 21, 1997; January 23, 1997, 1-3 read first time and referred to Committee on Economic Development; 1-4 March 24, 1997, reported adversely, with favorable Committee 1-5 Substitute by the following vote: Yeas 9, Nays 0; March 24, 1997, 1-6 sent to printer.) 1-7 COMMITTEE SUBSTITUTE FOR S.B. No. 258 By: Ellis 1-8 A BILL TO BE ENTITLED 1-9 AN ACT 1-10 relating to coverage under certain health benefit plans of tests 1-11 for the detection of prostate cancer. 1-12 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-13 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-14 amended by adding Article 21.53F to read as follows: 1-15 Art. 21.53F. COVERAGE OF CERTAIN TESTS FOR DETECTION OF 1-16 PROSTATE CANCER 1-17 Sec. 1. DEFINITION. In this article, "health benefit plan" 1-18 means a plan described by Section 2 of this article. 1-19 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to a 1-20 health benefit plan that: 1-21 (1) provides benefits for medical or surgical expenses 1-22 incurred as a result of a health condition, accident, or sickness, 1-23 including: 1-24 (A) an individual, group, blanket, or franchise 1-25 insurance policy or insurance agreement, a group hospital service 1-26 contract, or an individual or group evidence of coverage that is 1-27 offered by: 1-28 (i) an insurance company; 1-29 (ii) a group hospital service corporation 1-30 operating under Chapter 20 of this code; 1-31 (iii) a fraternal benefit society 1-32 operating under Chapter 10 of this code; 1-33 (iv) a stipulated premium insurance 1-34 company operating under Chapter 22 of this code; or 1-35 (v) a health maintenance organization 1-36 operating under the Texas Health Maintenance Organization Act 1-37 (Chapter 20A, Vernon's Texas Insurance Code); and 1-38 (B) to the extent permitted by the Employee 1-39 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 1-40 seq.), a health benefit plan that is offered by: 1-41 (i) a multiple employer welfare 1-42 arrangement as defined by Section 3, Employee Retirement Income 1-43 Security Act of 1974 (29 U.S.C. Section 1002); or 1-44 (ii) another analogous benefit 1-45 arrangement; 1-46 (2) is offered by an approved nonprofit health 1-47 corporation that is certified under Section 5.01(a), Medical 1-48 Practice Act (Article 4495b, Vernon's Texas Civil Statutes), and 1-49 that holds a certificate of authority issued by the commissioner 1-50 under Article 21.52F of this code; or 1-51 (3) is offered by any other entity not licensed under 1-52 this code or another insurance law of this state that contracts 1-53 directly for health care services on a risk-sharing basis, 1-54 including an entity that contracts for health care services on a 1-55 capitation basis. 1-56 (b) This article does not apply to: 1-57 (1) a plan that provides coverage: 1-58 (A) only for a specified disease; 1-59 (B) only for accidental death or dismemberment; 1-60 (C) for wages or payments in lieu of wages for a 1-61 period during which an employee is absent from work because of 1-62 sickness or injury; or 1-63 (D) as a supplement to liability insurance; 1-64 (2) a plan written under Chapter 26 of this code; 2-1 (3) a Medicare supplemental policy as defined by 2-2 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); 2-3 (4) workers' compensation insurance coverage; 2-4 (5) medical payment insurance issued as part of a 2-5 motor vehicle insurance policy; or 2-6 (6) a long-term care policy, including a nursing home 2-7 fixed indemnity policy, unless the commissioner determines that the 2-8 policy provides benefit coverage so comprehensive that the policy 2-9 is a health benefit plan as described by Subsection (a) of this 2-10 section. 2-11 Sec. 3. REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE 2-12 DETECTION OF PROSTATE CANCER. (a) A health benefit plan that 2-13 provides benefits for diagnostic medical procedures must provide 2-14 coverage for each male enrolled in the plan for expenses incurred 2-15 in conducting an annual medically recognized diagnostic examination 2-16 for the detection of prostate cancer. 2-17 (b) The minimum benefits provided under Subsection (a) of 2-18 this section must include: 2-19 (1) a physical examination for the detection of 2-20 prostate cancer; and 2-21 (2) a prostate-specific antigen test used for the 2-22 detection of prostate cancer for each male enrolled in the plan who 2-23 is: 2-24 (A) at least 50 years of age and asymptomatic; 2-25 or 2-26 (B) at least 40 years of age with a family 2-27 history of prostate cancer or another prostate cancer risk factor. 2-28 Sec. 4. NOTICE. Each health benefit plan shall provide 2-29 written notice to each person enrolled in the plan regarding the 2-30 coverage required by this article. The notice must be provided in 2-31 accordance with rules adopted by the commissioner. 2-32 Sec. 5. RULES. The commissioner shall adopt rules as 2-33 necessary to administer this article. 2-34 SECTION 2. This Act takes effect September 1, 1997, and 2-35 applies only to a health benefit plan that is delivered, issued for 2-36 delivery, or renewed on or after January 1, 1998. A plan that is 2-37 delivered, issued for delivery, or renewed before January 1, 1998, 2-38 is governed by the law as it existed immediately before the 2-39 effective date of this Act, and that law is continued in effect for 2-40 that purpose. 2-41 SECTION 3. The importance of this legislation and the 2-42 crowded condition of the calendars in both houses create an 2-43 emergency and an imperative public necessity that the 2-44 constitutional rule requiring bills to be read on three several 2-45 days in each house be suspended, and this rule is hereby suspended. 2-46 * * * * *