Texas 2021 - 87th Regular

Texas Senate Bill SB1028 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	S.B. No. 1028
	1	+	By: Huffman, et al. S.B. No. 1028
	2	+	(Smithee, Capriglione, Price, Guerra, Vo, et al.)
2	3
3	4
	5	+	A BILL TO BE ENTITLED
4	6		AN ACT
5	7		relating to health benefit plan coverage for colorectal cancer
6	8		early detection.
7	9		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
8	10		SECTION 1. Section 1363.001, Insurance Code, is amended to
9	11		read as follows:
10	12		Sec. 1363.001. APPLICABILITY OF CHAPTER. This chapter
11	13		applies only to a health benefit plan, including a small employer
12	14		health benefit plan written under Chapter 1501 or coverage that is
13	15		provided by a health group cooperative under Subchapter B of that
14	16		chapter, that:
15	17		(1) provides benefits for medical or surgical expenses
16	18		incurred as a result of a health condition, accident, or sickness,
17	19		including:
18	20		(A) an individual, group, blanket, or franchise
19	21		insurance policy or insurance agreement, a group hospital service
20	22		contract, or an individual or group evidence of coverage that is
21	23		offered by:
22	24		(i) an insurance company;
23	25		(ii) a group hospital service corporation
24	26		operating under Chapter 842;
25	27		(iii) a fraternal benefit society operating
26	28		under Chapter 885;
27	29		(iv) a Lloyd's plan operating under Chapter
28	30		941;
29	31		(v) a stipulated premium company operating
30	32		under Chapter 884; [or]
31	33		(vi) a health maintenance organization
32	34		operating under Chapter 843; or
33	35		(vii) a reciprocal or interinsurance
34	36		exchange operating under Chapter 942; and
35	37		(B) to the extent permitted by the Employee
36	38		Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et
37	39		seq.), a health benefit plan that is offered by:
38	40		(i) a multiple employer welfare arrangement
39	41		as defined by Section 3 of that Act; or
40	42		(ii) another analogous benefit
41	43		arrangement;
42	44		(2) is offered by an approved nonprofit health
43	45		corporation operating under Chapter 844; or
44	46		(3) provides health and accident coverage through a
45	47		risk pool created under Chapter 172, Local Government Code,
46	48		notwithstanding Section 172.014, Local Government Code, or any
47	49		other law.
48	50		SECTION 2. Section 1363.002, Insurance Code, is amended to
49	51		read as follows:
50	52		Sec. 1363.002. EXCEPTION. This chapter does not apply to:
51	53		(1) a plan that provides coverage:
52	54		(A) only for a specified disease or other limited
53	55		benefit;
54	56		(B) only for accidental death or dismemberment;
55	57		(C) for wages or payments in lieu of wages for a
56	58		period during which an employee is absent from work because of
57	59		sickness or injury;
58	60		(D) as a supplement to a liability insurance
59	61		policy; [or]
60	62		(E) only for indemnity for hospital confinement;
61	63		or
62	64		(F) only for dental or vision care;
63	65		(2) [a small employer health benefit plan written
64	66		under Chapter 1501;
65	67		[(3)] a Medicare supplemental policy as defined by
66	68		Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
67	69		as amended;
68	70		(3) a credit-only insurance policy;
69	71		(4) a workers' compensation insurance policy;
70	72		(5) medical payment insurance coverage provided under
71	73		a motor vehicle insurance policy; [or]
72	74		(6) a limited benefit policy that does not provide
73	75		coverage for physical examinations or wellness exams;
74	76		(7) a multiple employer welfare arrangement that holds
75	77		a certificate of authority under Chapter 846; or
76	78		(8) [(6)] a long-term care policy, including a nursing
77	79		home fixed indemnity policy, unless the commissioner determines
78	80		that the policy provides benefit coverage so comprehensive that the
79	81		policy is a health benefit plan as described by Section 1363.001.
80	82		SECTION 3. Section 1363.003, Insurance Code, is amended to
81	83		read as follows:
82	84		Sec. 1363.003. MINIMUM COVERAGE REQUIRED. (a) A health
83	85		benefit plan that provides coverage for screening medical
84	86		procedures must provide to each individual enrolled in the plan who
85	87		is 45 [50] years of age or older and at normal risk for developing
86	88		colon cancer coverage for expenses incurred in conducting a
87	89		medically recognized screening examination for the detection of
88	90		colorectal cancer.
89	91		(b) The minimum coverage required under this section must
90	92		include:
91	93		(1) all colorectal cancer examinations, preventive
92	94		services, and laboratory tests assigned a grade of "A" or "B" by the
93	95		United States Preventive Services Task Force for average-risk
94	96		individuals, including the services that may be assigned a grade of
95	97		"A" or "B" in the future [a fecal occult blood test performed
96	98		annually and a flexible sigmoidoscopy performed every five years];
97	99		and [or]
98	100		(2) an initial colonoscopy or other medical test or
99	101		procedure for colorectal cancer screening and a follow-up
100	102		colonoscopy if the results of the initial colonoscopy, test, or
101	103		procedure are abnormal [a colonoscopy performed every 10 years].
102	104		(c) For an enrollee in a managed care plan as defined by
103	105		Section 1451.151, the plan may impose a cost-sharing requirement
104	106		for coverage described by this section only if the enrollee obtains
105	107		the covered benefit or service outside the plan's network.
106	108		SECTION 4. The change in law made by this Act applies only
107	109		to a health benefit plan that is delivered, issued for delivery, or
108	110		renewed on or after January 1, 2022. A health benefit plan that is
109	111		delivered, issued for delivery, or renewed before January 1, 2022,
110	112		is governed by the law as it existed immediately before the
111	113		effective date of this Act, and that law is continued in effect for
112	114		that purpose.
113	115		SECTION 5. This Act takes effect September 1, 2021.
114		-	______________________________ ______________________________
115		-	President of the Senate Speaker of the House
116		-	I hereby certify that S.B. No. 1028 passed the Senate on
117		-	April 23, 2021, by the following vote: Yeas 30, Nays 1.
118		-	______________________________
119		-	Secretary of the Senate
120		-	I hereby certify that S.B. No. 1028 passed the House on
121		-	May 18, 2021, by the following vote: Yeas 121, Nays 16, two
122		-	present not voting.
123		-	______________________________
124		-	Chief Clerk of the House
125		-	Approved:
126		-	______________________________
127		-	Date
128		-	______________________________
129		-	Governor