Texas 2009 - 81st Regular

Texas House Bill HB1759 Compare Versions

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1	1	81R6630 PB-D
2	2	By: Thompson H.B. No. 1759
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 orally
8	8	administered anticancer medications.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Chapter 1369, Insurance Code, is amended by
11	11	adding Subchapter E to read as follows:
12	12	SUBCHAPTER E. COVERAGE FOR CERTAIN ORALLY ADMINISTERED ANTICANCER
13	13	MEDICATIONS
14	14	Sec. 1369.201. DEFINITION. In this subchapter, "enrollee"
15	15	means an individual entitled to coverage under a health benefit
16	16	plan.
17	17	Sec. 1369.202. APPLICABILITY OF SUBCHAPTER. (a) This
18	18	subchapter applies only to a health benefit plan, including a small
19	19	employer health benefit plan written under Chapter 1501 or coverage
20	20	provided by a health group cooperative under Subchapter B of that
21	21	chapter, that provides benefits for medical or surgical expenses
22	22	incurred as a result of a health condition, accident, or sickness,
23	23	including an individual, group, blanket, or franchise insurance
24	24	policy or insurance agreement, a group hospital service contract,
25	25	or an individual or group evidence of coverage or similar coverage
26	26	document that is offered by:
27	27	(1) an insurance company;
28	28	(2) a group hospital service corporation operating
29	29	under Chapter 842;
30	30	(3) a fraternal benefit society operating under
31	31	Chapter 885;
32	32	(4) a stipulated premium company operating under
33	33	Chapter 884;
34	34	(5) an exchange operating under Chapter 942;
35	35	(6) a Lloyd's plan operating under Chapter 941;
36	36	(7) a health maintenance organization operating under
37	37	Chapter 843;
38	38	(8) a multiple employer welfare arrangement that holds
39	39	a certificate of authority under Chapter 846; or
40	40	(9) an approved nonprofit health corporation that
41	41	holds a certificate of authority under Chapter 844.
42	42	(b) Notwithstanding Section 172.014, Local Government Code,
43	43	or any other law, this subchapter applies to health and accident
44	44	coverage provided by a risk pool created under Chapter 172, Local
45	45	Government Code.
46	46	(c) Notwithstanding any provision in Chapter 1551, 1575,
47	47	1579, or 1601 or any other law, this subchapter applies to:
48	48	(1) a basic coverage plan under Chapter 1551;
49	49	(2) a basic plan under Chapter 1575;
50	50	(3) a primary care coverage plan under Chapter 1579;
51	51	and
52	52	(4) basic coverage under Chapter 1601.
53	53	(d) Notwithstanding any other law, a standard health
54	54	benefit plan provided under Chapter 1507 must provide the coverage
55	55	required by this subchapter.
56	56	Sec. 1369.203. EXCEPTION. This subchapter does not apply
57	57	to:
58	58	(1) a plan that provides coverage:
59	59	(A) only for benefits for a specified disease or
60	60	for another limited benefit, other than a plan that provides
61	61	benefits for cancer treatment or similar services;
62	62	(B) only for accidental death or dismemberment;
63	63	(C) for wages or payments in lieu of wages for a
64	64	period during which an employee is absent from work because of
65	65	sickness or injury;
66	66	(D) as a supplement to a liability insurance
67	67	policy;
68	68	(E) only for dental or vision care; or
69	69	(F) only for indemnity for hospital confinement;
70	70	(2) a Medicare supplemental policy as defined by
71	71	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
72	72	(3) a workers' compensation insurance policy;
73	73	(4) medical payment insurance coverage provided under
74	74	an automobile insurance policy;
75	75	(5) a credit insurance policy;
76	76	(6) a limited benefit policy that does not provide
77	77	coverage for physical examinations or wellness exams; or
78	78	(7) a long-term care insurance policy, including a
79	79	nursing home fixed indemnity policy, unless the commissioner
80	80	determines that the policy provides benefit coverage so
81	81	comprehensive that the policy is a health benefit plan as described
82	82	by Section 1369.202.
83	83	Sec. 1369.204. REQUIRED COVERAGE FOR CERTAIN ORALLY
84	84	ADMINISTERED ANTICANCER MEDICATIONS. A health benefit plan that
85	85	provides coverage for chemotherapy treatment of cancer must provide
86	86	coverage for a prescribed, orally administered anticancer
87	87	medication that is used to kill or slow the growth of cancerous
88	88	cells on a basis no less favorable than intravenously administered
89	89	or injected cancer medications that are covered as medical benefits
90	90	by the plan.
91	91	SECTION 2. Subchapter E, Chapter 1369, Insurance Code, as
92	92	added by this Act, applies only to a health benefit plan that is
93	93	delivered, issued for delivery, or renewed on or after January 1,
94	94	2010. A health benefit plan that is delivered, issued for delivery,
95	95	or renewed before January 1, 2010, is covered by the law in effect
96	96	at the time the plan was delivered, issued for delivery, or renewed,
97	97	and that law is continued in effect for that purpose.
98	98	SECTION 3. This Act takes effect September 1, 2009.