Texas 2021 - 87th Regular

Texas House Bill HB3588 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	87R9496 MWC-F
2	2	By: Smithee H.B. No. 3588
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for colorectal cancer
8	8	early detection.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1363.001, Insurance Code, is amended to
11	11	read as follows:
12	12	Sec. 1363.001. APPLICABILITY OF CHAPTER. This chapter
13	13	applies only to a health benefit plan, including a small employer
14	14	health benefit plan written under Chapter 1501 or coverage that is
15	15	provided by a health group cooperative under Subchapter B of that
16	16	chapter, that:
17	17	(1) provides benefits for medical or surgical expenses
18	18	incurred as a result of a health condition, accident, or sickness,
19	19	including:
20	20	(A) an individual, group, blanket, or franchise
21	21	insurance policy or insurance agreement, a group hospital service
22	22	contract, or an individual or group evidence of coverage that is
23	23	offered by:
24	24	(i) an insurance company;
25	25	(ii) a group hospital service corporation
26	26	operating under Chapter 842;
27	27	(iii) a fraternal benefit society operating
28	28	under Chapter 885;
29	29	(iv) a Lloyd's plan operating under Chapter
30	30	941;
31	31	(v) a stipulated premium company operating
32	32	under Chapter 884; [or]
33	33	(vi) a health maintenance organization
34	34	operating under Chapter 843; or
35	35	(vii) a reciprocal or interinsurance
36	36	exchange operating under Chapter 942; and
37	37	(B) to the extent permitted by the Employee
38	38	Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
39	39	seq.), a health benefit plan that is offered by:
40	40	(i) a multiple employer welfare arrangement
41	41	as defined by Section 3 of that Act; or
42	42	(ii) another analogous benefit
43	43	arrangement;
44	44	(2) is offered by an approved nonprofit health
45	45	corporation operating under Chapter 844; or
46	46	(3) provides health and accident coverage through a
47	47	risk pool created under Chapter 172, Local Government Code,
48	48	notwithstanding Section 172.014, Local Government Code, or any
49	49	other law.
50	50	SECTION 2. Section 1363.002, Insurance Code, is amended to
51	51	read as follows:
52	52	Sec. 1363.002. EXCEPTION. This chapter does not apply to:
53	53	(1) a plan that provides coverage:
54	54	(A) only for a specified disease or other limited
55	55	benefit;
56	56	(B) only for accidental death or dismemberment;
57	57	(C) for wages or payments in lieu of wages for a
58	58	period during which an employee is absent from work because of
59	59	sickness or injury;
60	60	(D) as a supplement to a liability insurance
61	61	policy; [or]
62	62	(E) only for indemnity for hospital confinement;
63	63	or
64	64	(F) only for dental or vision care;
65	65	(2) [a small employer health benefit plan written
66	66	under Chapter 1501;
67	67	[(3)] a Medicare supplemental policy as defined by
68	68	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
69	69	as amended;
70	70	(3) a credit-only insurance policy;
71	71	(4) a workers' compensation insurance policy;
72	72	(5) medical payment insurance coverage provided under
73	73	a motor vehicle insurance policy; [or]
74	74	(6) a limited benefit policy that does not provide
75	75	coverage for physical examinations or wellness exams;
76	76	(7) a multiple employer welfare arrangement that holds
77	77	a certificate of authority under Chapter 846; or
78	78	(8) [(6)] a long-term care policy, including a nursing
79	79	home fixed indemnity policy, unless the commissioner determines
80	80	that the policy provides benefit coverage so comprehensive that the
81	81	policy is a health benefit plan as described by Section 1363.001.
82	82	SECTION 3. Section 1363.003, Insurance Code, is amended to
83	83	read as follows:
84	84	Sec. 1363.003. MINIMUM COVERAGE REQUIRED. (a) A health
85	85	benefit plan that provides coverage for screening medical
86	86	procedures must provide to each individual enrolled in the plan who
87	87	is 45 [50] years of age or older and at normal risk for developing
88	88	colon cancer coverage for expenses incurred in conducting a
89	89	medically recognized screening examination for the detection of
90	90	colorectal cancer.
91	91	(b) The minimum coverage required under this section must
92	92	include:
93	93	(1) all colorectal cancer examinations and laboratory
94	94	tests specified in the American Cancer Society guidelines for
95	95	colorectal cancer screening for average-risk individuals as those
96	96	guidelines existed on January 1, 2021, or a subsequent version of
97	97	those guidelines adopted by the commissioner by rule, performed at
98	98	the frequency recommended by those guidelines [a fecal occult
99	99	blood test performed annually and a flexible sigmoidoscopy
100	100	performed every five years]; and [or]
101	101	(2) an initial colonoscopy or other medical test or
102	102	procedure for colorectal cancer screening and a follow-up
103	103	colonoscopy if the results of the initial colonoscopy, test, or
104	104	procedure are abnormal [a colonoscopy performed every 10 years].
105	105	(c) For an enrollee in a managed care plan as defined by
106	106	Section 1451.151, the plan may impose a cost-sharing requirement
107	107	for coverage described by this section only if the enrollee obtains
108	108	the covered benefit or service outside the plan's network.
109	109	SECTION 4. The change in law made by this Act applies only
110	110	to a health benefit plan that is delivered, issued for delivery, or
111	111	renewed on or after January 1, 2022. A health benefit plan that is
112	112	delivered, issued for delivery, or renewed before January 1, 2022,
113	113	is governed by the law as it existed immediately before the
114	114	effective date of this Act, and that law is continued in effect for
115	115	that purpose.
116	116	SECTION 5. This Act takes effect September 1, 2021.