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A BILL TO BE ENTITLED
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AN ACT
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relating to coverage for supplemental breast cancer screening under |
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certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. This Act shall be known as Henda's Law. |
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SECTION 2. Section 1201.005, Insurance Code, is amended to |
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read as follows: |
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Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a |
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reference to this chapter includes a reference to: |
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(1) Section 1202.052; |
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(2) Section 1271.005(a), to the extent that the |
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subsection relates to the applicability of Section 1201.105, and |
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Sections 1271.005(d) and (e); |
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(3) Chapter 1351; |
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(4) Subchapters C and E, Chapter 1355; |
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(5) Subchapter A, Chapter 1356; |
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(6) Chapter 1365; |
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(7) Subchapter A, Chapter 1367; and |
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(8) Subchapters A, B, and G, Chapter 1451. |
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SECTION 3. The heading to Chapter 1356, Insurance Code, is |
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amended to read as follows: |
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CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER |
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SCREENING |
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SECTION 4. Sections 1356.001 through 1356.005, Insurance |
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Code, are designated as Subchapter A, Chapter 1356, Insurance Code, |
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and a heading is added to Subchapter A to read as follows: |
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SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY |
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SECTION 5. Section 1356.001, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.001. DEFINITION. In this subchapter [chapter], |
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"low-dose mammography" means the x-ray examination of the breast |
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using equipment dedicated specifically for mammography, including |
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an x-ray tube, filter, compression device, screens, films, and |
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cassettes, with an average radiation exposure delivery of less than |
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one rad mid-breast, with two views for each breast. |
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SECTION 6. Section 1356.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This |
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subchapter [chapter] applies only to a health benefit plan that is |
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delivered, issued for delivery, or renewed in this state and that is |
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an individual or group accident and health insurance policy, |
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including a policy issued by a group hospital service corporation |
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operating under Chapter 842. |
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SECTION 7. Section 1356.003, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
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LAW. The provisions of Chapter 1201, including provisions relating |
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to the applicability, purpose, and enforcement of that chapter, |
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construction of policies under that chapter, rulemaking under that |
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chapter, and definitions of terms applicable in that chapter, apply |
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to this subchapter [chapter]. |
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SECTION 8. Section 1356.004, Insurance Code, is amended to |
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read as follows: |
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Sec. 1356.004. EXCEPTION. This subchapter [chapter] does |
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not apply to a plan that provides coverage only for a specified |
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disease or for another limited benefit. |
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SECTION 9. Chapter 1356, Insurance Code, is amended by |
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adding Subchapter B to read as follows: |
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SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING |
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Sec. 1356.051. DEFINITIONS. In this subchapter: |
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(1) "Health benefit exchange" means an American Health |
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Benefit Exchange administered by the federal government or created |
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under Section 1311(b), Patient Protection and Affordable Care Act |
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(42 U.S.C. Section 18031). |
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(2) "Qualified health plan" has the meaning assigned |
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by Section 1301(a), Patient Protection and Affordable Care Act (42 |
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U.S.C. Section 18021). |
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(3) "Supplemental breast cancer screening" means a |
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method of screening, including ultrasound imaging, that is designed |
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to supplement mammography by detecting breast cancers that may not |
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be visible using only mammography. |
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Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) an exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; or |
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(7) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) Notwithstanding Section 1501.251 or any other law, this |
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subchapter applies to coverage under a small employer health |
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benefit plan subject to Chapter 1501. |
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Sec. 1356.053. EXCEPTION. This subchapter does not apply |
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to: |
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(1) a plan that provides coverage: |
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(A) only for benefits for a specified disease or |
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for another limited benefit; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; |
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(E) for credit insurance; |
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(F) only for dental or vision care; |
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(G) only for hospital expenses; or |
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(H) only for indemnity for hospital confinement; |
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(2) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; |
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(5) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides benefit coverage so comprehensive that the policy |
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is a health benefit plan as described by Section 1356.052; or |
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(6) a qualified health plan offered through a health |
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benefit exchange. |
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Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An |
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issuer of a health benefit plan that provides coverage for |
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mammography, including coverage for low-dose mammography required |
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by Subchapter A, must also offer to provide coverage for |
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supplemental breast cancer screening as part of an annual |
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well-woman examination covered under the plan if a licensed health |
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care professional treating the enrollee or screening the enrollee |
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for breast cancer finds that the enrollee has: |
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(1) dense breast tissue, as defined by the Breast |
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Imaging Reporting and Database System (Fourth Edition) established |
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by the American College of Radiology; and |
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(2) additional risk factors determined under |
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Subsection (c) for breast cancer that warrant supplemental breast |
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cancer screening beyond mammography. |
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(b) An additional premium may be charged for the coverage |
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described by Subsection (a). |
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(c) The commissioner by rule shall determine risk factors |
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described by Subsection (a)(2) based on scientific research and |
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models for breast cancer. |
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SECTION 10. This Act applies only to a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2016. A health benefit plan that is delivered, issued |
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for delivery, or renewed before January 1, 2016, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 11. This Act takes effect September 1, 2015. |