H.B. No. 1290
AN ACT
relating to health benefit plan coverage for bariatric surgery and
for certain tests for the early detection of cardiovascular
disease.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1376 to read as follows:
CHAPTER 1376. CERTAIN TESTS FOR EARLY DETECTION OF CARDIOVASCULAR
DISEASE
Sec. 1376.001. APPLICABILITY OF CHAPTER. (a) This chapter
applies only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or an individual or group evidence of coverage that is
offered by:
(i) an insurance company;
(ii) a group hospital service corporation
operating under Chapter 842;
(iii) a fraternal benefit society operating
under Chapter 885;
(iv) a Lloyd's plan operating under Chapter
941;
(v) a stipulated premium company operating
under Chapter 884; or
(vi) a health maintenance organization
operating under Chapter 843;
(B) a health benefit plan that is offered by a
multiple employer welfare arrangement that holds a certificate of
authority under Chapter 846;
(C) a small employer health benefit plan written
under Chapter 1501; or
(D) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
or
(2) is offered by an approved nonprofit health
corporation operating under Chapter 844.
(b) Notwithstanding any provision in Chapter 1601 or any
other law, this chapter applies to basic coverage under Chapter
1601.
Sec. 1376.002. EXCEPTIONS. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease or other limited
benefit;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(D) as a supplement to a liability insurance
policy; or
(E) only for indemnity for hospital confinement;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy; or
(5) a long-term care policy, including a nursing home
fixed indemnity policy, unless the commissioner determines that the
policy provides benefit coverage so comprehensive that the policy
is a health benefit plan as described by Section 1376.001.
Sec. 1376.003. MINIMUM COVERAGE REQUIRED. (a) A health
benefit plan that provides coverage for screening medical
procedures must provide the minimum coverage required by this
section to each covered individual:
(1) who is:
(A) a male older than 45 years of age and younger
than 76 years of age; or
(B) a female older than 55 years of age and
younger than 76 years of age; and
(2) who:
(A) is diabetic; or
(B) has a risk of developing coronary heart
disease, based on a score derived using the Framingham Heart Study
coronary prediction algorithm, that is intermediate or higher.
(b) The minimum coverage required to be provided under this
section is coverage of up to $200 for one of the following
noninvasive screening tests for atherosclerosis and abnormal
artery structure and function every five years, performed by a
laboratory that is certified by a national organization recognized
by the commissioner by rule for the purposes of this section:
(1) computed tomography (CT) scanning measuring
coronary artery calcification; or
(2) ultrasonography measuring carotid intima-media
thickness and plaque.
SECTION 2. Subchapter E, Chapter 1551, Insurance Code, is
amended by adding Section 1551.225 to read as follows:
Sec. 1551.225. BARIATRIC SURGERY COVERAGE. (a) The board
of trustees shall develop a cost-neutral or cost-positive plan for
providing under the group benefits program bariatric surgery
coverage for employees eligible to participate in the program under
Section 1551.101.
(b) The board of trustees may adopt rules as necessary to
implement this section.
SECTION 3. The board of trustees of the Employees
Retirement System of Texas shall implement the plan required by
Section 1551.225, Insurance Code, as added by this Act, as soon as
practicable, but not later than September 1, 2010.
SECTION 4. The change in law made by this Act applies only
to a health benefit plan delivered, issued for delivery, or renewed
on or after January 1, 2010. A health benefit plan delivered,
issued for delivery, or renewed before January 1, 2010, is governed
by the law in effect immediately before the effective date of this
Act, and that law is continued in effect for that purpose.
SECTION 5. This Act takes effect September 1, 2009.
______________________________ ______________________________
President of the Senate Speaker of the House
I certify that H.B. No. 1290 was passed by the House on April
21, 2009, by the following vote: Yeas 87, Nays 57, 1 present, not
voting; and that the House concurred in Senate amendments to H.B.
No. 1290 on May 29, 2009, by the following vote: Yeas 99, Nays 43,
1 present, not voting.
______________________________
Chief Clerk of the House
I certify that H.B. No. 1290 was passed by the Senate, with
amendments, on May 23, 2009, by the following vote: Yeas 31, Nays
0.
______________________________
Secretary of the Senate
APPROVED: __________________
Date
__________________
Governor