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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit coverage for diagnostic examinations for |
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lung cancer. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1372 to read as follows: |
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CHAPTER 1372. CERTAIN TESTS FOR DETECTION OF LUNG CANCER |
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Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, an individual or group evidence of |
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coverage, or a similar coverage document, that is 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 health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) a reciprocal exchange operating under Chapter 942. |
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(b) This chapter applies to a small employer health benefit |
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plan written under Chapter 1501. |
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Sec. 1372.002. EXCEPTIONS. This chapter does not apply 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, other than a plan that provides |
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benefits for cancer treatment or similar services; |
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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) only for dental or vision care; or |
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(F) 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) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 533, Government Code; |
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(4) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(5) a workers' compensation insurance policy; |
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(6) medical payment insurance coverage provided under |
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an automobile insurance policy; |
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(7) a credit insurance policy; |
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(8) a limited benefit policy that does not provide |
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coverage for physical examinations or wellness exams; or |
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(9) a long-term care insurance policy, including a |
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nursing home fixed indemnity policy, unless the commissioner |
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determines that the policy provides benefit coverage so |
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comprehensive that the policy is a health benefit plan as described |
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by Section 1370.001. |
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Sec. 1372.003. COVERAGE REQUIRED. (a) A health benefit |
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plan that provides coverage for diagnostic medical procedures must |
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provide coverage for an annual medically recognized examination for |
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the early detection of lung cancer to each person enrolled in the |
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plan who is at least 50 years of age and: |
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(1) is a current or former smoker; or |
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(2) has: |
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(A) a personal or family history of lung cancer; |
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(B) a genetic risk factor associated with lung |
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cancer; |
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(C) been exposed to environmental or |
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occupational carcinogens; or |
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(D) been exposed to therapeutic radiation. |
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(b) A diagnostic examination required under this section |
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must be performed in accordance with the guidelines adopted by: |
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(1) the American Lung Association; or |
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(2) another similar national organization of medical |
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professionals recognized by the commissioner. |
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Sec. 1372.004. NOTICE OF COVERAGE. (a) A health benefit |
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plan issuer shall provide to each person enrolled in the plan |
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written notice of the coverage required under this chapter. |
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(b) The notice must be provided in accordance with rules |
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adopted by the commissioner. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan that is delivered, issued for delivery, or |
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renewed on or after January 1, 2024. |
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SECTION 3. This Act takes effect September 1, 2023. |