87R15990 JES-F
By: Collier H.B. No. 293
Substitute the following for H.B. No. 293:
By: Oliverson C.S.H.B. No. 293
A BILL TO BE ENTITLED
AN ACT
relating to health benefit coverage for certain fertility
preservation services under certain health benefit plans.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1366, Insurance Code, is amended by
adding Subchapter C to read as follows:
SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES
Sec. 1366.101. 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
issued in this state by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter applies
to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter; and
(2) a standard health benefit plan issued under
Chapter 1507.
Sec. 1366.102. EXCEPTIONS. (a) This subchapter does not
apply to:
(1) a plan that provides coverage:
(A) for wages or payments in lieu of wages for a
period during which an employee is absent from work because of
sickness or injury;
(B) as a supplement to a liability insurance
policy;
(C) for credit insurance;
(D) only for dental or vision care;
(E) only for hospital expenses; or
(F) 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(g)(1));
(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 1366.101;
(6) Medicaid managed care programs operated under
Chapter 533, Government Code;
(7) Medicaid programs operated under Chapter 32, Human
Resources Code; or
(8) the state child health plan operated under Chapter
62 or 63, Health and Safety Code.
(b) This subchapter does not apply to a qualified health
plan, as defined by 45 C.F.R. Section 155.20, if a determination is
made under 45 C.F.R. Section 155.170 that:
(1) this subchapter requires the qualified health plan
to offer benefits in addition to the essential health benefits
required under 42 U.S.C. Section 18022(b); and
(2) this state must make payments to defray the cost of
the additional benefits mandated by this subchapter.
(c) If a determination described by Subsection (b) is made
as to a qualified health plan, this subchapter does not apply to a
non-qualified health plan if the non-qualified health plan is
offered in the same market as the qualified health plan.
Sec. 1366.103. REQUIRED COVERAGE. (a) Subject to
Subsection (b), a health benefit plan must provide coverage for
fertility preservation services to a covered person who will
receive a medically necessary treatment, including surgery,
chemotherapy, and radiation, that the American Society of Clinical
Oncology or the American Society for Reproductive Medicine has
established may directly or indirectly cause impaired fertility.
(b) The fertility preservation services described by
Subsection (a) must be standard procedures to preserve fertility
consistent with established medical practices or professional
guidelines published by the American Society of Clinical Oncology
or the American Society for Reproductive Medicine.
SECTION 2. This Act applies only to a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2022.
SECTION 3. This Act takes effect September 1, 2021.