| 1 | 1 | | 86R6879 PMO-F |
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| 2 | 2 | | By: Menéndez S.B. No. 959 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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| 5 | 5 | | A BILL TO BE ENTITLED |
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| 6 | 6 | | AN ACT |
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| 7 | 7 | | relating to health benefit coverage for certain fertility |
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| 8 | 8 | | preservation services under certain health benefit plans. |
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| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 10 | 10 | | SECTION 1. Chapter 1366, Insurance Code, is amended by |
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| 11 | 11 | | adding Subchapter C to read as follows: |
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| 12 | 12 | | SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES |
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| 13 | 13 | | Sec. 1366.101. APPLICABILITY OF SUBCHAPTER. (a) This |
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| 14 | 14 | | subchapter applies only to a health benefit plan that provides |
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| 15 | 15 | | benefits for medical or surgical expenses incurred as a result of a |
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| 16 | 16 | | health condition, accident, or sickness, including an individual, |
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| 17 | 17 | | group, blanket, or franchise insurance policy or insurance |
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| 18 | 18 | | agreement, a group hospital service contract, or an individual or |
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| 19 | 19 | | group evidence of coverage or similar coverage document that is |
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| 20 | 20 | | issued in this state by: |
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| 21 | 21 | | (1) an insurance company; |
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| 22 | 22 | | (2) a group hospital service corporation operating |
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| 23 | 23 | | under Chapter 842; |
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| 24 | 24 | | (3) a health maintenance organization operating under |
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| 25 | 25 | | Chapter 843; |
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| 26 | 26 | | (4) an approved nonprofit health corporation that |
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| 27 | 27 | | holds a certificate of authority under Chapter 844; |
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| 28 | 28 | | (5) a multiple employer welfare arrangement that holds |
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| 29 | 29 | | a certificate of authority under Chapter 846; |
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| 30 | 30 | | (6) a stipulated premium company operating under |
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| 31 | 31 | | Chapter 884; |
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| 32 | 32 | | (7) a fraternal benefit society operating under |
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| 33 | 33 | | Chapter 885; |
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| 34 | 34 | | (8) a Lloyd's plan operating under Chapter 941; or |
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| 35 | 35 | | (9) an exchange operating under Chapter 942. |
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| 36 | 36 | | (b) Notwithstanding any other law, this subchapter applies |
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| 37 | 37 | | to: |
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| 38 | 38 | | (1) a small employer health benefit plan subject to |
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| 39 | 39 | | Chapter 1501, including coverage provided through a health group |
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| 40 | 40 | | cooperative under Subchapter B of that chapter; |
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| 41 | 41 | | (2) a standard health benefit plan issued under |
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| 42 | 42 | | Chapter 1507; |
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| 43 | 43 | | (3) a basic coverage plan under Chapter 1551; |
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| 44 | 44 | | (4) a basic plan under Chapter 1575; |
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| 45 | 45 | | (5) a primary care coverage plan under Chapter 1579; |
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| 46 | 46 | | (6) a plan providing basic coverage under Chapter |
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| 47 | 47 | | 1601; |
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| 48 | 48 | | (7) health benefits provided by or through a church |
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| 49 | 49 | | benefits board under Subchapter I, Chapter 22, Business |
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| 50 | 50 | | Organizations Code; |
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| 51 | 51 | | (8) group health coverage made available by a school |
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| 52 | 52 | | district in accordance with Section 22.004, Education Code; |
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| 53 | 53 | | (9) the state Medicaid program, including the Medicaid |
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| 54 | 54 | | managed care program operated under Chapter 533, Government Code; |
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| 55 | 55 | | (10) the child health plan program under Chapter 62, |
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| 56 | 56 | | Health and Safety Code; |
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| 57 | 57 | | (11) a regional or local health care program operated |
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| 58 | 58 | | under Section 75.104, Health and Safety Code; |
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| 59 | 59 | | (12) a self-funded health benefit plan sponsored by a |
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| 60 | 60 | | professional employer organization under Chapter 91, Labor Code; |
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| 61 | 61 | | (13) county employee group health benefits provided |
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| 62 | 62 | | under Chapter 157, Local Government Code; and |
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| 63 | 63 | | (14) health and accident coverage provided by a risk |
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| 64 | 64 | | pool created under Chapter 172, Local Government Code. |
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| 65 | 65 | | Sec. 1366.102. EXCEPTIONS. This subchapter does not apply |
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| 66 | 66 | | to: |
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| 67 | 67 | | (1) a plan that provides coverage: |
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| 68 | 68 | | (A) for wages or payments in lieu of wages for a |
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| 69 | 69 | | period during which an employee is absent from work because of |
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| 70 | 70 | | sickness or injury; |
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| 71 | 71 | | (B) as a supplement to a liability insurance |
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| 72 | 72 | | policy; |
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| 73 | 73 | | (C) for credit insurance; |
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| 74 | 74 | | (D) only for dental or vision care; |
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| 75 | 75 | | (E) only for hospital expenses; or |
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| 76 | 76 | | (F) only for indemnity for hospital confinement; |
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| 77 | 77 | | (2) a Medicare supplemental policy as defined by |
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| 78 | 78 | | Section 1882(g)(1), Social Security Act (42 U.S.C. Section |
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| 79 | 79 | | 1395ss(g)(1)); |
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| 80 | 80 | | (3) a workers' compensation insurance policy; |
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| 81 | 81 | | (4) medical payment insurance coverage provided under |
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| 82 | 82 | | a motor vehicle insurance policy; or |
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| 83 | 83 | | (5) a long-term care policy, including a nursing home |
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| 84 | 84 | | fixed indemnity policy, unless the commissioner determines that the |
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| 85 | 85 | | policy provides benefit coverage so comprehensive that the policy |
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| 86 | 86 | | is a health benefit plan as described by Section 1366.001. |
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| 87 | 87 | | Sec. 1366.103. REQUIRED COVERAGE. (a) Subject to |
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| 88 | 88 | | Subsection (b), a health benefit plan must provide coverage for |
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| 89 | 89 | | fertility preservation services to a covered person who will |
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| 90 | 90 | | receive a medically necessary treatment, including surgery, |
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| 91 | 91 | | chemotherapy, and radiation, that the American Society of Clinical |
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| 92 | 92 | | Oncology or the American Society for Reproductive Medicine has |
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| 93 | 93 | | established may directly or indirectly cause impaired fertility. |
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| 94 | 94 | | (b) The fertility preservation services described by |
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| 95 | 95 | | Subsection (a) must be standard procedures to preserve fertility |
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| 96 | 96 | | consistent with established medical practices or professional |
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| 97 | 97 | | guidelines published by the American Society of Clinical Oncology |
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| 98 | 98 | | or the American Society for Reproductive Medicine. |
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| 99 | 99 | | SECTION 2. This Act applies only to a health benefit plan |
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| 100 | 100 | | that is delivered, issued for delivery, or renewed on or after |
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| 101 | 101 | | January 1, 2020. |
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| 102 | 102 | | SECTION 3. This Act takes effect September 1, 2019. |
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