By: Moncrief, Lindsay, Zaffirini S.B. No. 1467 A BILL TO BE ENTITLED 1-1 AN ACT 1-2 relating to coverage for tests for the detection of colorectal 1-3 cancer under certain health benefit plans. 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 21.53S to read as follows: 1-7 Art. 21.53S. COVERAGE OF CERTAIN TESTS FOR DETECTION OF 1-8 COLORECTAL CANCER 1-9 Sec. 1. DEFINITION. In this article, "health benefit plan" 1-10 means a plan described by Section 2 of this article. 1-11 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to a 1-12 health benefit plan that: 1-13 (1) provides benefits for medical or surgical expenses 1-14 incurred as a result of a health condition, accident, or sickness, 1-15 including: 1-16 (A) an individual, group, blanket, or franchise 1-17 insurance policy or insurance agreement, a group hospital service 1-18 contract, or an individual or group evidence of coverage that is 1-19 offered by: 1-20 (i) an insurance company; 1-21 (ii) a group hospital service corporation 1-22 operating under Chapter 20 of this code; 1-23 (iii) a fraternal benefit society 1-24 operating under Chapter 10 of this code; 1-25 (iv) a stipulated premium insurance 2-1 company operating under Chapter 22 of this code; or 2-2 (v) a health maintenance organization 2-3 operating under the Texas Health Maintenance Organization Act 2-4 (Chapter 20A, Vernon's Texas Insurance Code); and 2-5 (B) to the extent permitted by the Employee 2-6 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 2-7 seq.), a health benefit plan that is offered by: 2-8 (i) a multiple employer welfare 2-9 arrangement as defined by Section 3, Employee Retirement Income 2-10 Security Act of 1974 (29 U.S.C. Section 1002); or 2-11 (ii) another analogous benefit 2-12 arrangement; 2-13 (2) is offered by an approved nonprofit health 2-14 corporation that is certified under Section 162.001, Occupations 2-15 Code, and that holds a certificate of authority issued by the 2-16 commissioner under Article 21.52F of this code; 2-17 (3) is offered by any other entity not licensed under 2-18 this code or another insurance law of this state that contracts 2-19 directly for health care services on a risk-sharing basis, 2-20 including an entity that contracts for health care services on a 2-21 capitation basis; or 2-22 (4) notwithstanding Section 172.014, Local Government 2-23 Code, or any other law, provides health and accident coverage 2-24 through a risk pool created under Chapter 172, Local Government 2-25 Code. 2-26 (b) This article does not apply to: 3-1 (1) a plan that provides coverage: 3-2 (A) only for a specified disease or other 3-3 limited benefit; 3-4 (B) only for accidental death or dismemberment; 3-5 (C) for wages or payments in lieu of wages for a 3-6 period during which an employee is absent from work because of 3-7 sickness or injury; 3-8 (D) as a supplement to liability insurance; or 3-9 (E) only for indemnity for hospital confinement; 3-10 (2) a plan written under Chapter 26 of this code; 3-11 (3) a Medicare supplemental policy as defined by 3-12 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 3-13 as amended; 3-14 (4) workers' compensation insurance coverage; 3-15 (5) medical payment insurance issued as part of a 3-16 motor vehicle insurance policy; or 3-17 (6) a long-term care policy, including a nursing home 3-18 fixed indemnity policy, unless the commissioner determines that the 3-19 policy provides benefit coverage so comprehensive that the policy 3-20 is a health benefit plan as described by Subsection (a) of this 3-21 section. 3-22 Sec. 3. REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE 3-23 DETECTION OF COLORECTAL CANCER. (a) A health benefit plan that 3-24 provides benefits for diagnostic medical procedures must provide 3-25 coverage for each person enrolled in the plan who is 50 years of 3-26 age or older for expenses incurred in conducting a medically 4-1 recognized diagnostic examination for the detection of colorectal 4-2 cancer. 4-3 (b) The minimum benefits provided under Subsection (a) of 4-4 this section must include: 4-5 (1) a fecal occult blood test, performed annually; 4-6 (2) a flexible sigmoidoscopy with hemoccult of the 4-7 stool, performed every five years; and 4-8 (3) a colonoscopy performed every 10 years. 4-9 Sec. 4. NOTICE. Each health benefit plan shall provide 4-10 written notice to each person enrolled in the plan regarding the 4-11 coverage required by this article. The notice must be provided in 4-12 accordance with rules adopted by the commissioner. 4-13 Sec. 5. RULES. The commissioner shall adopt rules as 4-14 necessary to administer this article. 4-15 SECTION 2. This Act takes effect September 1, 2001, and 4-16 applies only to a health benefit plan that is delivered, issued for 4-17 delivery, or renewed on or after January 1, 2002. A plan that is 4-18 delivered, issued for delivery, or renewed before January 1, 2002, 4-19 is governed by the law as it existed immediately before the 4-20 effective date of this Act, and that law is continued in effect for 4-21 that purpose.