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 Lloyd's plan operating under
2-1 Chapter 18 of this code;
2-2 (v) a stipulated premium insurance company
2-3 operating under Chapter 22 of this code; or
2-4 (vi) a health maintenance organization
2-5 operating under the Texas Health Maintenance Organization Act
2-6 (Chapter 20A, Vernon's Texas Insurance Code); and
2-7 (B) to the extent permitted by the Employee
2-8 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
2-9 seq.), a health benefit plan that is offered by:
2-10 (i) a multiple employer welfare
2-11 arrangement as defined by Section 3, Employee Retirement Income
2-12 Security Act of 1974 (29 U.S.C. Section 1002); or
2-13 (ii) another analogous benefit
2-14 arrangement;
2-15 (2) is offered by an approved nonprofit health
2-16 corporation that is certified under Section 162.001, Occupations
2-17 Code, and that holds a certificate of authority issued by the
2-18 commissioner under Article 21.52F of this code; or
2-19 (3) notwithstanding Section 172.014, Local Government
2-20 Code, or any other law, provides health and accident coverage
2-21 through a risk pool created under Chapter 172, Local Government
2-22 Code.
2-23 (b) This article does not apply to:
2-24 (1) a plan that provides coverage:
2-25 (A) only for a specified disease or other
2-26 limited benefit;
3-1 (B) only for accidental death or dismemberment;
3-2 (C) for wages or payments in lieu of wages for a
3-3 period during which an employee is absent from work because of
3-4 sickness or injury;
3-5 (D) as a supplement to liability insurance; or
3-6 (E) only for indemnity for hospital confinement;
3-7 (2) a small employer plan written under Chapter 26 of
3-8 this code;
3-9 (3) a Medicare supplemental policy as defined by
3-10 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-11 as amended;
3-12 (4) workers' compensation insurance coverage;
3-13 (5) medical payment insurance issued as part of a
3-14 motor vehicle insurance policy; or
3-15 (6) a long-term care policy, including a nursing home
3-16 fixed indemnity policy, unless the commissioner determines that the
3-17 policy provides benefit coverage so comprehensive that the policy
3-18 is a health benefit plan as described by Subsection (a) of this
3-19 section.
3-20 Sec. 3. REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE
3-21 DETECTION OF COLORECTAL CANCER. (a) A health benefit plan that
3-22 provides benefits for screening medical procedures must provide
3-23 coverage for each person enrolled in the plan who is 50 years of
3-24 age or older and at normal risk for developing colon cancer for
3-25 expenses incurred in conducting a medically recognized screening
3-26 examination for the detection of colorectal cancer.
4-1 (b) The minimum benefits provided under Subsection (a) of
4-2 this section must:
4-3 (1) include:
4-4 (A) a fecal occult blood test performed
4-5 annually; and
4-6 (B) a flexible sigmoidoscopy performed every
4-7 five years; or
4-8 (2) include 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.
_______________________________ _______________________________
President of the Senate Speaker of the House
I hereby certify that S.B. No. 1467 passed the Senate on
May 1, 2001, by a viva-voce vote; and that the Senate concurred in
House amendment on May 24, 2001, by a viva-voce vote.
_______________________________
Secretary of the Senate
I hereby certify that S.B. No. 1467 passed the House, with
amendment, on May 18, 2001, by a non-record vote.
_______________________________
Chief Clerk of the House
Approved:
_______________________________
Date
_______________________________
Governor