Texas 2009 - 81st Regular

Texas House Bill HB191 Compare Versions

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11 81R2467 KCR-D
22 By: Alonzo H.B. No. 191
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55 A BILL TO BE ENTITLED
66 AN ACT
77 relating to the coverage by certain health benefit plans of
88 mammograms performed by certain health care providers.
99 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1010 SECTION 1. Chapter 1356, Insurance Code, is amended to read
1111 as follows:
1212 CHAPTER 1356. LOW-DOSE MAMMOGRAPHY
1313 SUBCHAPTER A. GENERAL PROVISIONS
1414 Sec. 1356.001. DEFINITIONS. [DEFINITION.] In this
1515 chapter:
1616 (1) "Enrollee" means an individual enrolled in a
1717 health benefit plan.
1818 (2) "Low-dose mammography" [, "low-dose mammography"]
1919 means the x-ray examination of the breast using equipment dedicated
2020 specifically for mammography, including an x-ray tube, filter,
2121 compression device, screens, films, and cassettes, with an average
2222 radiation exposure delivery of less than one rad mid-breast, with
2323 two views for each breast.
2424 Sec. 1356.002. APPLICABILITY OF CHAPTER. This chapter
2525 applies only to a health benefit plan that is delivered, issued for
2626 delivery, or renewed in this state and that is an individual or
2727 group accident and health insurance policy, including a policy
2828 issued by a group hospital service corporation operating under
2929 Chapter 842.
3030 Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
3131 LAW. The provisions of Chapter 1201, including provisions
3232 relating to the applicability, purpose, and enforcement of that
3333 chapter, construction of policies under that chapter, rulemaking
3434 under that chapter, and definitions of terms applicable in that
3535 chapter, apply to this chapter.
3636 Sec. 1356.004. EXCEPTION. This chapter does not apply to a
3737 plan that provides coverage only for a specified disease or for
3838 another limited benefit.
3939 [Sections 1356.005-1356.050 reserved for expansion]
4040 SUBCHAPTER B. COVERAGE OF CERTAIN PROCEDURES REQUIRED
4141 Sec. 1356.051. [Sec. 1356.005.] COVERAGE REQUIRED. (a) A
4242 health benefit plan that provides coverage to a female who is 35
4343 years of age or older must include coverage for an annual screening
4444 by low-dose mammography for the presence of occult breast cancer.
4545 (b) Coverage required by this section:
4646 (1) may not be less favorable than coverage for other
4747 radiological examinations under the plan; and
4848 (2) must be subject to the same dollar limits,
4949 deductibles, and coinsurance factors as coverage for other
5050 radiological examinations under the plan.
5151 [Sections 1356.052-1356.100 reserved for expansion]
5252 SUBCHAPTER C. CHOICE OF PROVIDER
5353 Sec. 1356.101. APPLICABILITY OF SUBCHAPTER. In addition to
5454 a health benefit plan subject to this chapter under Sections
5555 1356.002 and 1356.003, this subchapter also applies to a health
5656 benefit plan that is delivered, issued for delivery, or renewed in
5757 this state and that is an individual or group evidence of coverage
5858 issued by a health maintenance organization operating under Chapter
5959 843.
6060 Sec. 1356.102. CHOICE OF PROVIDER; PRIOR APPROVAL. (a) A
6161 health benefit plan that provides coverage for low-dose mammography
6262 must allow an enrollee to have a covered mammogram performed by a
6363 physician or provider selected by the enrollee other than the
6464 enrollee's primary care physician or primary care provider.
6565 (b) A health benefit plan may require an enrollee to receive
6666 prior approval before having a covered mammogram performed by a
6767 physician or provider other than the enrollee's primary care
6868 physician or primary care provider.
6969 (c) This section does not affect the authority of a health
7070 benefit issuer to establish selection criteria for physicians and
7171 providers who provide services under the plan.
7272 SECTION 2. The change in law made by this Act applies only
7373 to a health benefit plan that is delivered, issued for delivery, or
7474 renewed on or after January 1, 2010. A health benefit plan that is
7575 delivered, issued for delivery, or renewed before January 1, 2010,
7676 is covered by the law in effect at the time the health benefit plan
7777 was delivered, issued for delivery, or renewed, and that law is
7878 continued in effect for that purpose.
7979 SECTION 3. This Act takes effect September 1, 2009.