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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 cancer screening, |
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imaging, and genetic testing. |
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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 1373 to read as follows: |
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CHAPTER 1373. COVERAGE FOR CANCER SCREENING, IMAGING, AND GENETIC |
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TESTING |
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Sec. 1373.001. DEFINITION. In this chapter, "nationally |
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recognized clinical practice guidelines" means evidence-based |
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clinical practice guidelines that: |
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(1) establish a standard of care informed by a |
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systematic review of evidence and an assessment of the benefits and |
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costs of alternative care options; |
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(2) include recommendations intended to optimize |
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patient care; and |
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(3) are developed by an independent organization or |
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medical professional society that uses a transparent methodology |
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and reporting structure and is subject to a conflict of interest |
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policy. |
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Sec. 1373.002. 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, or an individual or group contract |
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or similar coverage document that is issued 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) Notwithstanding any other law, this chapter applies to: |
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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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and |
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(6) a plan providing basic coverage under Chapter |
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1601. |
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Sec. 1373.003. COVERAGE FOR CANCER SCREENING AND IMAGING. |
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A health benefit plan must provide coverage for preventive cancer |
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screening and imaging for enrollees who have an increased risk of |
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developing cancer if the screening or imaging is: |
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(1) ordered by a health care provider; and |
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(2) supported by nationally recognized clinical |
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practice guidelines. |
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Sec. 1373.004. COVERAGE FOR GENETIC TESTING. A health |
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benefit plan must provide coverage for germline testing for an |
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inherited mutation associated with an increased risk of cancer. |
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if the testing is: |
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(1) ordered by a health care provider; and |
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(2) supported by nationally recognized clinical |
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practice guidelines. |
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Sec. 1373.005. COPAYMENT, DEDUCTIBLE, OR COINSURANCE |
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REQUIREMENT PROHIBITED. (a) Coverage required under this chapter |
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may not be made subject to a deductible, copayment, or coinsurance |
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requirement. |
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(b) Notwithstanding Subsection (a), if not subjecting an |
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enrollee to a deductible for genetic testing or cancer screening or |
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imaging under this chapter would cause an enrollee enrolled in a |
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high deductible health plan, as that term is defined by Section 223, |
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Internal Revenue Code of 1986, who has established a health savings |
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account under that section, to become ineligible for that plan, a |
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health benefit plan issuer shall waive the deductible only after |
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the enrollee has satisfied the minimum deductible under the plan, |
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except with respect to preventive care services for which the |
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enrollee is not required to meet a deductible in accordance with |
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Section 223(c)(2)(C), Internal Revenue Code of 1986. |
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SECTION 2. Chapter 1373, Insurance Code, as added by this |
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Act, applies only to a health benefit plan delivered, issued for |
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delivery, or renewed on or after January 1, 2026. |
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SECTION 3. This Act takes effect September 1, 2025. |