84R4537 PMO-D
By: Hernandez, Sheets, Guerra H.B. No. 694
A BILL TO BE ENTITLED
AN ACT
relating to coverage for supplemental breast cancer screening under
certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. This Act shall be known as Henda's Law.
SECTION 2. Section 1201.005, Insurance Code, is amended to
read as follows:
Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a
reference to this chapter includes a reference to:
(1) Section 1202.052;
(2) Section 1271.005(a), to the extent that the
subsection relates to the applicability of Section 1201.105, and
Sections 1271.005(d) and (e);
(3) Chapter 1351;
(4) Subchapters C and E, Chapter 1355;
(5) Subchapter A, Chapter 1356;
(6) Chapter 1365;
(7) Subchapter A, Chapter 1367; and
(8) Subchapters A, B, and G, Chapter 1451.
SECTION 3. The heading to Chapter 1356, Insurance Code, is
amended to read as follows:
CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER
SCREENING
SECTION 4. Sections 1356.001 through 1356.005, Insurance
Code, are designated as Subchapter A, Chapter 1356, Insurance Code,
and a heading is added to Subchapter A to read as follows:
SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY
SECTION 5. Section 1356.001, Insurance Code, is amended to
read as follows:
Sec. 1356.001. DEFINITION. In this subchapter [chapter],
"low-dose mammography" means the x-ray examination of the breast
using equipment dedicated specifically for mammography, including
an x-ray tube, filter, compression device, screens, films, and
cassettes, with an average radiation exposure delivery of less than
one rad mid-breast, with two views for each breast.
SECTION 6. Section 1356.002, Insurance Code, is amended to
read as follows:
Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This
subchapter [chapter] applies only to a health benefit plan that is
delivered, issued for delivery, or renewed in this state and that is
an individual or group accident and health insurance policy,
including a policy issued by a group hospital service corporation
operating under Chapter 842.
SECTION 7. Section 1356.003, Insurance Code, is amended to
read as follows:
Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER
LAW. The provisions of Chapter 1201, including provisions relating
to the applicability, purpose, and enforcement of that chapter,
construction of policies under that chapter, rulemaking under that
chapter, and definitions of terms applicable in that chapter, apply
to this subchapter [chapter].
SECTION 8. Section 1356.004, Insurance Code, is amended to
read as follows:
Sec. 1356.004. EXCEPTION. This subchapter [chapter] does
not apply to a plan that provides coverage only for a specified
disease or for another limited benefit.
SECTION 9. Chapter 1356, Insurance Code, is amended by
adding Subchapter B to read as follows:
SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING
Sec. 1356.051. DEFINITIONS. In this subchapter:
(1) "Health benefit exchange" means an American Health
Benefit Exchange administered by the federal government or created
under Section 1311(b), Patient Protection and Affordable Care Act
(42 U.S.C. Section 18031).
(2) "Qualified health plan" has the meaning assigned
by Section 1301(a), Patient Protection and Affordable Care Act (42
U.S.C. Section 18021).
(3) "Supplemental breast cancer screening" means a
method of screening, including ultrasound imaging, that is designed
to supplement mammography by detecting breast cancers that may not
be visible using only mammography.
Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses incurred as a result of a
health condition, accident, or sickness, including an individual,
group, blanket, or franchise insurance policy or insurance
agreement, a group hospital service contract, or an individual or
group evidence of coverage or similar coverage document that is
offered by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a fraternal benefit society operating under
Chapter 885;
(4) a stipulated premium company operating under
Chapter 884;
(5) an exchange operating under Chapter 942;
(6) a health maintenance organization operating under
Chapter 843; or
(7) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844.
(b) Notwithstanding Section 1501.251 or any other law, this
subchapter applies to coverage under a small employer health
benefit plan subject to Chapter 1501.
Sec. 1356.053. EXCEPTION. This subchapter does not apply
to:
(1) a plan that provides coverage:
(A) only for benefits for a specified disease or
for another 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;
(E) for credit insurance;
(F) only for dental or vision care;
(G) only for hospital expenses; or
(H) only for indemnity for hospital confinement;
(2) a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under
a motor vehicle insurance policy;
(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 1356.052; or
(6) a qualified health plan offered through a health
benefit exchange.
Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An
issuer of a health benefit plan that provides coverage for
mammography, including coverage for low-dose mammography required
by Subchapter A, must also offer to provide coverage for
supplemental breast cancer screening as part of an annual
well-woman examination covered under the plan if a licensed health
care professional treating the enrollee or screening the enrollee
for breast cancer finds that the enrollee has:
(1) dense breast tissue, as defined by the Breast
Imaging Reporting and Database System (Fourth Edition) established
by the American College of Radiology; and
(2) additional risk factors determined under
Subsection (c) for breast cancer that warrant supplemental breast
cancer screening beyond mammography.
(b) An additional premium may be charged for the coverage
described by Subsection (a).
(c) The commissioner by rule shall determine risk factors
described by Subsection (a)(2) based on scientific research and
models for breast cancer.
SECTION 10. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2016. A health benefit plan that is delivered, issued
for delivery, or renewed before January 1, 2016, is governed by the
law as it existed immediately before the effective date of this Act,
and that law is continued in effect for that purpose.
SECTION 11. This Act takes effect September 1, 2015.