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.