Texas 2009 - 81st Regular

Texas House Bill HB1290 Compare Versions

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1	1	81R4381 AJA-D
2	2	By: Oliveira H.B. No. 1290
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for certain tests for the
8	8	early detection of cardiovascular disease.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
11	11	by adding Chapter 1376 to read as follows:
12	12	CHAPTER 1376. CERTAIN TESTS FOR EARLY DETECTION OF CARDIOVASCULAR
13	13	DISEASE
14	14	Sec. 1376.001. APPLICABILITY OF CHAPTER. (a) This chapter
15	15	applies only to a health benefit plan that:
16	16	(1) provides benefits for medical or surgical expenses
17	17	incurred as a result of a health condition, accident, or sickness,
18	18	including:
19	19	(A) an individual, group, blanket, or franchise
20	20	insurance policy or insurance agreement, a group hospital service
21	21	contract, or an individual or group evidence of coverage that is
22	22	offered by:
23	23	(i) an insurance company;
24	24	(ii) a group hospital service corporation
25	25	operating under Chapter 842;
26	26	(iii) a fraternal benefit society operating
27	27	under Chapter 885;
28	28	(iv) a Lloyd's plan operating under Chapter
29	29	941;
30	30	(v) a stipulated premium company operating
31	31	under Chapter 884; or
32	32	(vi) a health maintenance organization
33	33	operating under Chapter 843;
34	34	(B) to the extent permitted by the Employee
35	35	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
36	36	seq.), a health benefit plan that is offered by:
37	37	(i) a multiple employer welfare arrangement
38	38	as defined by Section 3 of that Act (29 U.S.C. Section 1002); or
39	39	(ii) another analogous benefit
40	40	arrangement;
41	41	(C) a small employer health benefit plan written
42	42	under Chapter 1501;
43	43	(D) a standard health benefit plan issued under
44	44	Chapter 1507; or
45	45	(E) a Medicare supplemental policy as defined by
46	46	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
47	47	(2) is offered by an approved nonprofit health
48	48	corporation operating under Chapter 844; or
49	49	(3) provides health and accident coverage through a
50	50	risk pool created under Chapter 172, Local Government Code,
51	51	notwithstanding Section 172.014, Local Government Code.
52	52	(b) Notwithstanding any provision in Chapter 1601 or any
53	53	other law, this chapter applies to basic coverage under Chapter
54	54	1601.
55	55	Sec. 1376.002. EXCEPTION. This chapter does not apply to:
56	56	(1) a plan that provides coverage:
57	57	(A) only for a specified disease or other limited
58	58	benefit;
59	59	(B) only for accidental death or dismemberment;
60	60	(C) for wages or payments in lieu of wages for a
61	61	period during which an employee is absent from work because of
62	62	sickness or injury;
63	63	(D) as a supplement to a liability insurance
64	64	policy; or
65	65	(E) only for indemnity for hospital confinement;
66	66	(2) a workers' compensation insurance policy;
67	67	(3) medical payment insurance coverage provided under
68	68	a motor vehicle insurance policy; or
69	69	(4) a long-term care policy, including a nursing home
70	70	fixed indemnity policy, unless the commissioner determines that the
71	71	policy provides benefit coverage so comprehensive that the policy
72	72	is a health benefit plan as described by Section 1376.001.
73	73	Sec. 1376.003. MINIMUM COVERAGE REQUIRED. (a) A health
74	74	benefit plan that provides coverage for screening medical
75	75	procedures must provide the minimum coverage required by this
76	76	section to each covered individual:
77	77	(1) who is:
78	78	(A) a male older than 45 years of age and younger
79	79	than 76 years of age; or
80	80	(B) a female older than 55 years of age and
81	81	younger than 76 years of age; and
82	82	(2) who:
83	83	(A) is diabetic; or
84	84	(B) has a risk of developing coronary heart
85	85	disease, based on a score derived using the Framingham Heart Study
86	86	coronary prediction algorithm, that is intermediate or higher.
87	87	(b) The minimum coverage required to be provided under this
88	88	section is coverage of up to $200 for one of the following
89	89	noninvasive screening tests for atherosclerosis and abnormal
90	90	artery structure and function every five years, performed by a
91	91	laboratory that is certified by a national organization recognized
92	92	by the commissioner by rule for the purposes of this section:
93	93	(1) computed tomography (CT) scanning measuring
94	94	coronary artery calcification; or
95	95	(2) ultrasonography measuring carotid intima-media
96	96	thickness and plaque.
97	97	SECTION 2. The change in law made by this Act applies only
98	98	to a health benefit plan delivered, issued for delivery, or renewed
99	99	on or after January 1, 2010. A health benefit plan delivered,
100	100	issued for delivery, or renewed before January 1, 2010, is governed
101	101	by the law in effect immediately before the effective date of this
102	102	Act, and that law is continued in effect for that purpose.
103	103	SECTION 3. This Act takes effect September 1, 2009.