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79R4163 PB-D
By: Thompson H.B. No. 1485
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for screening tests for
human papillomavirus and cervical cancer.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, as
effective April 1, 2005, is amended by adding Chapter 1370 to read
as follows:
CHAPTER 1370. CERTAIN TESTS FOR DETECTION OF HUMAN PAPILLOMAVIRUS
AND CERVICAL CANCER
Sec. 1370.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that provides benefits for
medical or surgical expenses incurred as a result of a health
condition, accident, or sickness, including an individual, group,
blanket, or franchise insurance policy or insurance agreement, a
group hospital service contract, an individual or group evidence of
coverage, or a similar coverage document, that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) a health maintenance organization operating under
Chapter 843;
(6) a reciprocal exchange operating under Chapter 942;
(7) a Lloyd's plan operating under Chapter 941;
(8) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844; or
(9) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846.
(b) This chapter applies to a small employer health benefit
plan written under Chapter 1501.
Sec. 1370.002. EXCEPTION. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for benefits for a specified disease or
for another limited benefit, other than a plan that provides
benefits for cancer treatment or similar services;
(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) only for dental or vision care; or
(F) 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);
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
an automobile insurance policy;
(5) a credit insurance policy; or
(6) 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 Section 1370.001.
Sec. 1370.003. COVERAGE REQUIRED. (a) A health benefit
plan that provides coverage for diagnostic medical procedures must
provide to each woman 18 years of age or older enrolled in the plan
coverage for expenses for an annual medically recognized diagnostic
examination for the early detection of cervical cancer.
(b) Coverage required under this section includes at a
minimum a conventional Pap smear screening or a screening using
liquid-based cytology methods, as approved by the United States
Food and Drug Administration, alone or in combination with a test
approved by the United States Food and Drug Administration for the
detection of the human papillomavirus.
(c) A screening test required under this section must be
performed in accordance with the guidelines adopted by:
(1) the American College of Obstetricians and
Gynecologists; or
(2) another similar national organization of medical
professionals recognized by the commissioner.
Sec. 1370.004. NOTICE OF COVERAGE. (a) A health benefit
plan issuer shall provide to each woman 18 years of age or older
enrolled in the plan written notice of the coverage required under
this chapter.
(b) The notice must be provided in accordance with rules
adopted by the commissioner.
SECTION 2. Section 3(b), Article 3.80, Insurance Code, is
amended to read as follows:
(b) For purposes of this article, "state-mandated health
benefits" does not include benefits that are mandated by federal
law or standard provisions or rights required under this code or
other laws of this state to be provided in an individual, blanket,
or group policy for accident and health insurance that are
unrelated to specific health illnesses, injuries, or conditions of
an insured, including provisions related to:
(1) continuation of coverage under:
(A) Subchapters F and G, Chapter 1251, [Section
1(d)(3) and Section 3B, Article 3.51-6] of this code;
(B) Section 1201.059 of this code [2(C), Chapter
397, Acts of the 54th Legislature, Regular Session, 1955 (Article
3.70-2, Vernon's Texas Insurance Code)]; and
(C) Subchapter B, Chapter 1253, [Article 3.51-8]
of this code[; and
[(D) Section 3C, Article 3.51-6 of this code, as
added by Section 10, Chapter 1041, Acts of the 71st Legislature,
Regular Session, 1989];
(2) termination of coverage under Sections 1202.051
and 1501.108 [Articles 3.70-1A, 26.23, and 26.86] of this code;
(3) preexisting conditions under Subchapter D,
Chapter 1201, and Sections 1501.102-1501.105 [Section 1(H),
Chapter 397, Acts of the 54th Legislature, Regular Session, 1955
(Article 3.70-1, Vernon's Texas Insurance Code), and Articles 26.49
and 26.90] of this code;
(4) coverage of children, including newborn or adopted
children, under:
(A) Subchapter D, Chapter 1251, [Sections 1, 3D,
and 3E, Article 3.51-6] of this code;
(B) Sections 1201.053, 1201.061,
1201.063-1201.065, and Subchapter A, Chapter 1367, of this code
[2(A), (E), (K), and (M), Chapter 397, Acts of the 54th Legislature,
Regular Session, 1955 (Article 3.70-2, Vernon's Texas Insurance
Code)];
(C) Chapter 1504 [Subchapter J, Chapter 3] of
this code;
(D) Chapter 1503 [Article 21.24-2] of this code;
(E) Section 1501.157 [Article 26.21(n)] of this
code;
(F) Section 1501.158 [Article 26.21A] of this
code; and
(G) Sections 1501.607-1501.609 [Article 26.84]
of this code;
(5) services of practitioners under:
(A) Subchapters A, B, and C, Chapter 1451,
[Article 21.52] of this code; or
(B) Section 1301.052 [Article 3.70-3C] of this
code[, as added by Chapter 1260, Acts of the 75th Legislature,
Regular Session, 1997; or
[(C) Section 2(B), Chapter 397, Acts of the 54th
Legislature, Regular Session, 1955 (Article 3.70-2, Vernon's Texas
Insurance Code)];
(6) supplies and services associated with the
treatment of diabetes under Subchapter B, Chapter 1358, [Article
21.53G] of this code;
(7) coverage for serious mental illness under
Subchapter A, Chapter 1355, [Article 3.51-14 of this code if the
standard health benefit plan is issued to a large employer as
defined by Article 26.02] of this code;
(8) coverage for childhood immunizations and hearing
screening as required by:
(A) Subchapters B and C, Chapter 1367, [Article
21.53F] of this code, other than Section 1367.053(c); and
(B) Chapter 1353 [as added by Chapter 683, Acts
of the 75th Legislature, Regular Session, 1997, and Article 21.53K]
of this code;
(9) coverage for reconstructive surgery for certain
craniofacial abnormalities of children as required by Subchapter D,
Chapter 1367, [Article 21.53W] of this code;
(10) coverage for the dietary treatment of
phenylketonuria as required by Chapter 1359 [Article 3.79] of this
code;
(11) coverage for referral to a non-network physician
or provider when medically necessary covered services are not
available through network physicians or providers, as required by
Section 1271.055 [Article 20A.09(a)(3)(C)] of this code; and
(12) coverage for cancer screenings under the
following chapters [articles] of this code:
(A) Chapter 1356 [Article 3.70-2(H), as added by
Chapter 1091, Acts of the 70th Legislature, Regular Session, 1987];
(B) Chapter 1362 [Article 21.53F, as added by
Chapter 1287, Acts of the 75th Legislature, Regular Session, 1997];
[and]
(C) Chapter 1363; and
(D) Chapter 1370 [Article 21.53S].
SECTION 3. Subsection (d), Article 20A.09N, Insurance Code,
is amended to read as follows:
(d) For purposes of this section, "state-mandated health
benefits" does not include coverage that is mandated by federal law
or standard provisions or rights required under the Insurance Code
or other law of this state to be provided in an evidence of coverage
that are unrelated to specific health illnesses, injuries, or
conditions of an insured, including provisions related to:
(1) continuation of coverage under Subchapter G,
Chapter 1251 [Section 3B, Article 3.51-6], Insurance Code;
(2) termination of coverage under Sections 1202.051
and 1501.108 [Articles 3.70-1A, 26.23, and 26.86], Insurance Code;
(3) preexisting conditions under Subchapter D,
Chapter 1201, Insurance Code, and Sections 1501.102-1501.105
[Section 1(H), Chapter 397, Acts of the 54th Legislature, Regular
Session, 1955 (Article 3.70-1, Vernon's Texas Insurance Code), and
Articles 26.49 and 26.90], Insurance Code;
(4) coverage of children, including newborn or adopted
children, under:
(A) Chapter 1504 [Subchapter J, Chapter 3],
Insurance Code;
(B) Chapter 1503 [Article 21.24-2], Insurance
Code;
(C) Section 1501.157 [Article 26.21(n)],
Insurance Code;
(D) Section 1501.158 [Article 26.21A], Insurance
Code; and
(E) Sections 1501.607-1501.609 [Article 26.84],
Insurance Code;
(5) services of providers under Section 843.304,
Insurance Code [of this code];
(6) coverage for serious mental health illness under
Subchapter A, Chapter 1355 [Article 3.51-14], Insurance Code [, if
the standard health benefit plan is issued to a large employer as
defined in Article 26.02, Insurance Code]; and
(7) coverage for cancer screenings under the following
chapters [articles] of the Insurance Code [this code]:
(A) Chapter 1356, Insurance Code [Article
3.70-2(H), as added by Chapter 1091, Acts of the 70th Legislature,
Regular Session, 1987];
(B) Chapter 1362, Insurance Code [Article
21.53F, as added by Chapter 1287, Acts of the 75th Legislature,
Regular Session, 1997]; [and]
(C) Chapter 1363, Insurance Code; and
(D) Chapter 1370, Insurance Code [Article
21.53S].
SECTION 4. The change in law made by this Act applies only
to a health benefit plan delivered, issued for delivery, or renewed
on or after January 1, 2006. A health benefit plan delivered,
issued for delivery, or renewed before January 1, 2006, 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 5. To the extent of any conflict, this Act prevails
over another Act of the 79th Legislature, Regular Session, 2005,
relating to nonsubstantive additions to and corrections in enacted
codes (the General Code Update bill).
SECTION 6. This Act takes effect September 1, 2005.