1-1 By: Moncrief S.B. No. 1467 1-2 (In the Senate - Filed March 8, 2001; March 13, 2001, read 1-3 first time and referred to Committee on Business and Commerce; 1-4 April 27, 2001, reported favorably by the following vote: Yeas 6, 1-5 Nays 0; April 27, 2001, sent to printer.) 1-6 A BILL TO BE ENTITLED 1-7 AN ACT 1-8 relating to coverage for tests for the detection of colorectal 1-9 cancer under certain health benefit plans. 1-10 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: 1-11 SECTION 1. Subchapter E, Chapter 21, Insurance Code, is 1-12 amended by adding Article 21.53S to read as follows: 1-13 Art. 21.53S. COVERAGE OF CERTAIN TESTS FOR DETECTION OF 1-14 COLORECTAL CANCER 1-15 Sec. 1. DEFINITION. In this article, "health benefit plan" 1-16 means a plan described by Section 2 of this article. 1-17 Sec. 2. SCOPE OF ARTICLE. (a) This article applies to a 1-18 health benefit plan that: 1-19 (1) provides benefits for medical or surgical expenses 1-20 incurred as a result of a health condition, accident, or sickness, 1-21 including: 1-22 (A) an individual, group, blanket, or franchise 1-23 insurance policy or insurance agreement, a group hospital service 1-24 contract, or an individual or group evidence of coverage that is 1-25 offered by: 1-26 (i) an insurance company; 1-27 (ii) a group hospital service corporation 1-28 operating under Chapter 20 of this code; 1-29 (iii) a fraternal benefit society 1-30 operating under Chapter 10 of this code; 1-31 (iv) a stipulated premium insurance 1-32 company operating under Chapter 22 of this code; or 1-33 (v) a health maintenance organization 1-34 operating under the Texas Health Maintenance Organization Act 1-35 (Chapter 20A, Vernon's Texas Insurance Code); and 1-36 (B) to the extent permitted by the Employee 1-37 Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 1-38 seq.), a health benefit plan that is offered by: 1-39 (i) a multiple employer welfare 1-40 arrangement as defined by Section 3, Employee Retirement Income 1-41 Security Act of 1974 (29 U.S.C. Section 1002); or 1-42 (ii) another analogous benefit 1-43 arrangement; 1-44 (2) is offered by an approved nonprofit health 1-45 corporation that is certified under Section 162.001, Occupations 1-46 Code, and that holds a certificate of authority issued by the 1-47 commissioner under Article 21.52F of this code; 1-48 (3) is offered by any other entity not licensed under 1-49 this code or another insurance law of this state that contracts 1-50 directly for health care services on a risk-sharing basis, 1-51 including an entity that contracts for health care services on a 1-52 capitation basis; or 1-53 (4) notwithstanding Section 172.014, Local Government 1-54 Code, or any other law, provides health and accident coverage 1-55 through a risk pool created under Chapter 172, Local Government 1-56 Code. 1-57 (b) This article does not apply to: 1-58 (1) a plan that provides coverage: 1-59 (A) only for a specified disease or other 1-60 limited benefit; 1-61 (B) only for accidental death or dismemberment; 1-62 (C) for wages or payments in lieu of wages for a 1-63 period during which an employee is absent from work because of 1-64 sickness or injury; 2-1 (D) as a supplement to liability insurance; or 2-2 (E) only for indemnity for hospital confinement; 2-3 (2) a plan written under Chapter 26 of this code; 2-4 (3) a Medicare supplemental policy as defined by 2-5 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 2-6 as amended; 2-7 (4) workers' compensation insurance coverage; 2-8 (5) medical payment insurance issued as part of a 2-9 motor vehicle insurance policy; or 2-10 (6) a long-term care policy, including a nursing home 2-11 fixed indemnity policy, unless the commissioner determines that the 2-12 policy provides benefit coverage so comprehensive that the policy 2-13 is a health benefit plan as described by Subsection (a) of this 2-14 section. 2-15 Sec. 3. REQUIRED COVERAGE FOR CERTAIN TESTS FOR THE 2-16 DETECTION OF COLORECTAL CANCER. (a) A health benefit plan that 2-17 provides benefits for diagnostic medical procedures must provide 2-18 coverage for each person enrolled in the plan who is 50 years of 2-19 age or older for expenses incurred in conducting a medically 2-20 recognized diagnostic examination for the detection of colorectal 2-21 cancer. 2-22 (b) The minimum benefits provided under Subsection (a) of 2-23 this section must include: 2-24 (1) a fecal occult blood test, performed annually; 2-25 (2) a flexible sigmoidoscopy with hemoccult of the 2-26 stool, performed every five years; and 2-27 (3) a colonoscopy performed every 10 years. 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, 2001, 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, 2002. A plan that is 2-37 delivered, issued for delivery, or renewed before January 1, 2002, 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 * * * * *