87R9496 MWC-F
By: Smithee H.B. No. 3588
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for colorectal cancer
early detection.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Section 1363.001, Insurance Code, is amended to
read as follows:
Sec. 1363.001. APPLICABILITY OF CHAPTER. This chapter
applies only to a health benefit plan, including a small employer
health benefit plan written under Chapter 1501 or coverage that is
provided by a health group cooperative under Subchapter B of that
chapter, that:
(1) provides benefits for medical or surgical expenses
incurred as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise
insurance policy or insurance agreement, a group hospital service
contract, or an individual or group evidence of coverage that is
offered by:
(i) an insurance company;
(ii) a group hospital service corporation
operating under Chapter 842;
(iii) a fraternal benefit society operating
under Chapter 885;
(iv) a Lloyd's plan operating under Chapter
941;
(v) a stipulated premium company operating
under Chapter 884; [or]
(vi) a health maintenance organization
operating under Chapter 843; or
(vii) a reciprocal or interinsurance
exchange operating under Chapter 942; and
(B) to the extent permitted by the Employee
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
seq.), a health benefit plan that is offered by:
(i) a multiple employer welfare arrangement
as defined by Section 3 of that Act; or
(ii) another analogous benefit
arrangement;
(2) is offered by an approved nonprofit health
corporation operating under Chapter 844; or
(3) provides health and accident coverage through a
risk pool created under Chapter 172, Local Government Code,
notwithstanding Section 172.014, Local Government Code, or any
other law.
SECTION 2. Section 1363.002, Insurance Code, is amended to
read as follows:
Sec. 1363.002. EXCEPTION. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease or other 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; [or]
(E) only for indemnity for hospital confinement;
or
(F) only for dental or vision care;
(2) [a small employer health benefit plan written
under Chapter 1501;
[(3)] a Medicare supplemental policy as defined by
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
as amended;
(3) a credit-only insurance policy;
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under
a motor vehicle insurance policy; [or]
(6) a limited benefit policy that does not provide
coverage for physical examinations or wellness exams;
(7) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846; or
(8) [(6)] 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 1363.001.
SECTION 3. Section 1363.003, Insurance Code, is amended to
read as follows:
Sec. 1363.003. MINIMUM COVERAGE REQUIRED. (a) A health
benefit plan that provides coverage for screening medical
procedures must provide to each individual enrolled in the plan who
is 45 [50] years of age or older and at normal risk for developing
colon cancer coverage for expenses incurred in conducting a
medically recognized screening examination for the detection of
colorectal cancer.
(b) The minimum coverage required under this section must
include:
(1) all colorectal cancer examinations and laboratory
tests specified in the American Cancer Society guidelines for
colorectal cancer screening for average-risk individuals as those
guidelines existed on January 1, 2021, or a subsequent version of
those guidelines adopted by the commissioner by rule, performed at
the frequency recommended by those guidelines [a fecal occult
blood test performed annually and a flexible sigmoidoscopy
performed every five years]; and [or]
(2) an initial colonoscopy or other medical test or
procedure for colorectal cancer screening and a follow-up
colonoscopy if the results of the initial colonoscopy, test, or
procedure are abnormal [a colonoscopy performed every 10 years].
(c) For an enrollee in a managed care plan as defined by
Section 1451.151, the plan may impose a cost-sharing requirement
for coverage described by this section only if the enrollee obtains
the covered benefit or service outside the plan's network.
SECTION 4. The change in law made by this Act applies only
to a health benefit plan that is delivered, issued for delivery, or
renewed on or after January 1, 2022. A health benefit plan that is
delivered, issued for delivery, or renewed before January 1, 2022,
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 5. This Act takes effect September 1, 2021.