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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for certain tests to |
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detect prostate cancer. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Section 1362.001, Insurance Code, is amended to |
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read as follows: |
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Sec. 1362.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that[: |
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[(1)] provides benefits for medical or surgical |
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expenses incurred as a result of a health condition, accident, or |
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sickness, including[: |
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[(A)] an individual, group, blanket, or |
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franchise insurance policy or insurance agreement, a group hospital |
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service contract, or an individual or group evidence of coverage |
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that is offered by: |
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(1) [(i)] an insurance company; |
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(2) [(ii)] a group hospital service corporation |
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operating under Chapter 842; |
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(3) [(iii)] a fraternal benefit society operating |
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under Chapter 885; |
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(4) [(iv)] a stipulated premium company operating |
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under Chapter 884; [or] |
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(5) [(v)] a health maintenance organization operating |
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under Chapter 843; |
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(6) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to |
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[and |
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[(B) to the extent permitted by the Employee |
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
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seq.), a health benefit plan that is offered by: |
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[(i) a multiple employer welfare |
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arrangement as defined by Section 3 of that Act; or |
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[(ii) another analogous benefit |
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arrangement; |
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[(2) is offered by]: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(8) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(9) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(10) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(11) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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and |
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(12) a health benefit plan offered by [(A) an approved |
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nonprofit health corporation that holds a certificate of authority |
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under Chapter 844; or |
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[(B)] an entity not authorized under this code or |
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another insurance law of this state that contracts directly for |
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health care services on a risk-sharing basis, including a |
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capitation basis[; or |
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[(3) provides health and accident coverage through a |
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risk pool created under Chapter 172, Local Government Code, |
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notwithstanding Section 172.014, Local Government Code, or any |
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other law]. |
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SECTION 2. Section 1362.002, Insurance Code, is amended to |
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read as follows: |
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Sec. 1362.002. EXCEPTION. This chapter does not apply to: |
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(1) a health benefit plan that provides coverage: |
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(A) only for a specified disease or for another |
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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; or |
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(E) only for indemnity for hospital confinement; |
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(2) [a small employer health benefit plan written |
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under Chapter 1501; |
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[(3)] 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) [(4)] a workers' compensation insurance policy; |
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(4) [(5)] medical payment insurance coverage provided |
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under a motor vehicle insurance policy; or |
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(5) [(6)] a long-term care insurance policy, |
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including a nursing home fixed indemnity policy, unless the |
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commissioner determines that the policy provides benefit coverage |
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so comprehensive that the policy is a health benefit plan as |
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described by Section 1362.001. |
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SECTION 3. Section 1362.003, Insurance Code, is amended by |
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adding Subsection (c) to read as follows: |
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(c) A health benefit plan that provides coverage under this |
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section may not charge any premium, copayment, coinsurance, |
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deductible, or any other form of cost sharing for a covered benefit |
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described by this section. |
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SECTION 4. Section 1575.159, Insurance Code, is repealed. |
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SECTION 5. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 6. The changes in law made by this Act apply only to |
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a health benefit plan delivered, issued for delivery, or renewed on |
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or after January 1, 2024. A health benefit plan delivered, issued |
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for delivery, or renewed before January 1, 2024, 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 7. This Act takes effect September 1, 2023. |