This website will be unavailable from Friday, April 26, 2024 at 6:00 p.m. through Monday, April 29, 2024 at 7:00 a.m. due to data center maintenance.

                                                                                

78R3691 AKH-D

By:  Lewis                                                        H.B. No. 1142



A BILL TO BE ENTITLED

AN ACT

relating to certain diagnostic tests and other care required to be 
provided by a health benefit plan.
	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:                        
	SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is 
amended by adding Article 21.53R to read as follows:
	Art. 21.53R. COVERAGE FOR CERTAIN REQUIRED DIAGNOSTIC TESTS 
AND EXAMINATIONS
	Sec. 1.  DEFINITION. In this article, "enrollee" means an 
individual enrolled in a health benefit plan.
	Sec. 2.  APPLICABILITY OF ARTICLE. (a) This article applies 
to each health benefit plan that provides benefits for medical or 
surgical expenses incurred as a result of a health condition, 
accident, or sickness, including a group, individual, blanket, or 
franchise insurance policy or insurance agreement, a hospital 
service contract, or an evidence of coverage or similar coverage 
document that is offered by:
		(1)  an insurance company;                                             
		(2)  a group hospital service corporation operating 
under Chapter 842 of this code;
		(3)  a fraternal benefit society operating under 
Chapter 885 of this code;
		(4)  a stipulated premium insurance company operating 
under Chapter 884 of this code;
		(5)  an exchange operating under Chapter 942 of this 
code;           
		(6)  a Lloyd's plan operating under Chapter 941 of this 
code;        
		(7)  a health maintenance organization operating under 
Chapter 843 of this code;
		(8)  a multiple employer welfare arrangement that holds 
a certificate of authority under Chapter 846 of this code; or
		(9)  an approved nonprofit health corporation that 
holds a certificate of authority under Chapter 844 of this code.
	(b)  This article does not apply to a small employer health 
benefit plan written under Chapter 26 of this code.
	(c)  This article does not apply to:                                    
		(1)  a plan that provides coverage:                                    
			(A)  only for benefits for a specified disease or 
for another limited benefit;
			(B)  only for accidental death or dismemberment;                      
			(C)  for wages or payments in lieu of wages for a 
period during which an employee is absent from work because of 
sickness or injury;
			(D)  as a supplement to a liability insurance 
policy;               
			(E)  for credit insurance;                                            
			(F)  only for dental or vision care;                                  
			(G)  only for hospital expenses; or                                   
			(H)  only for indemnity for hospital confinement;                     
		(2)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 
as amended;
		(3)  a workers' compensation insurance policy;                         
		(4)  medical payment insurance coverage provided under 
a motor vehicle insurance policy; or
		(5)  a long-term care insurance policy, including a 
nursing home fixed indemnity policy, unless the commissioner 
determines that the policy provides benefit coverage so 
comprehensive that the policy is a health benefit plan as described 
by Subsection (a) of this section.
	Sec. 3.  COVERAGE FOR REQUIRED EXAMINATION AND DIAGNOSTIC 
TESTS.  (a)  A health benefit plan must provide coverage for an 
annual comprehensive physical examination. As part of the physical 
examination, the health plan shall provide for certain 
age-appropriate diagnostic tests that include:
		(1)  blood hemoglobin, blood pressure, and blood 
glucose levels; and 
		(2)  blood cholesterol levels or low-density 
lipoprotein (LDL) levels and blood high-density lipoprotein (HDL) 
levels.
	(b)  A health benefit plan must provide coverage for the 
diagnostic tests and comprehensive physical examination required 
under this section as part of the basic health care services offered 
under the health benefit plan. The issuer of a health benefit plan 
may not assess an enrollee a deductible, copayment, or coinsurance 
requirement for access to the tests and consultation beyond the 
basic deductible, copayment, or coinsurance assessed for the office 
visit at which the tests are performed or the physical examination 
provided.
	(c)  The issuer of a health benefit plan shall provide to 
plan enrollees a written notice regarding the diagnostic tests and 
physical examination required by this section.
	Sec. 4.  RULES.  The commissioner may adopt rules as 
necessary to administer this article.
	SECTION 2.  Article 21.53R, Insurance Code, as added by this 
Act, applies only to a health benefit plan delivered, issued for 
delivery, or renewed on or after January 1, 2004.  A health benefit 
plan delivered, issued for delivery, or renewed before January 1, 
2004, is governed by the law as it existed immediately before the 
effective date of this Act, and that law is continued in effect for 
that purpose.
	SECTION 3.  This Act takes effect September 1, 2003.