Texas 2021 - 87th Regular

Texas Senate Bill SB1539 Compare Versions

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

Old	New	Differences
1	1	87R7198 MWC-D
2	2	By: Menéndez S.B. No. 1539
3	3
4	4
5	5	A BILL TO BE ENTITLED
6	6	AN ACT
7	7	relating to health benefit plan coverage for certain tests to
8	8	detect prostate cancer.
9	9	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
10	10	SECTION 1. Section 1362.001, Insurance Code, is amended to
11	11	read as follows:
12	12	Sec. 1362.001. APPLICABILITY OF CHAPTER. (a) This chapter
13	13	applies only to a health benefit plan that[:
14	14	[(1)] provides benefits for medical or surgical
15	15	expenses incurred as a result of a health condition, accident, or
16	16	sickness, including[:
17	17	[(A)] an individual, group, blanket, or
18	18	franchise insurance policy or insurance agreement, a group hospital
19	19	service contract, or an individual or group evidence of coverage
20	20	that is offered by:
21	21	(1) [(i)] an insurance company;
22	22	(2) [(ii)] a group hospital service corporation
23	23	operating under Chapter 842;
24	24	(3) [(iii)] a fraternal benefit society operating
25	25	under Chapter 885;
26	26	(4) [(iv)] a stipulated premium company operating
27	27	under Chapter 884; [or]
28	28	(5) [(v)] a health maintenance organization operating
29	29	under Chapter 843; [and]
30	30	(6) an approved nonprofit health corporation that
31	31	holds a certificate of authority under Chapter 844;
32	32	(7) a multiple employer welfare arrangement that holds
33	33	a certificate of authority under Chapter 846;
34	34	(8) a Lloyd's plan operating under Chapter 941; or
35	35	(9) an exchange operating under Chapter 942.
36	36	(b) Notwithstanding any other law, this chapter applies to
37	37	[(B) to the extent permitted by the Employee Retirement Income
38	38	Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health
39	39	benefit plan that is offered by:
40	40	[(i) a multiple employer welfare
41	41	arrangement as defined by Section 3 of that Act; or
42	42	[(ii) another analogous benefit
43	43	arrangement;
44	44	[(2) is offered by]:
45	45	(1) a small employer health benefit plan subject to
46	46	Chapter 1501, including coverage provided through a health group
47	47	cooperative under Subchapter B of that chapter;
48	48	(2) a standard health benefit plan issued under
49	49	Chapter 1507;
50	50	(3) a basic coverage plan under Chapter 1551;
51	51	(4) a basic plan under Chapter 1575;
52	52	(5) a primary care coverage plan under Chapter 1579;
53	53	(6) a plan providing basic coverage under Chapter
54	54	1601;
55	55	(7) health benefits provided by or through a church
56	56	benefits board under Subchapter I, Chapter 22, Business
57	57	Organizations Code;
58	58	(8) group health coverage made available by a school
59	59	district in accordance with Section 22.004, Education Code;
60	60	(9) the state Medicaid program, including the Medicaid
61	61	managed care program operated under Chapter 533, Government Code;
62	62	(10) the child health plan program under Chapter 62,
63	63	Health and Safety Code;
64	64	(11) a regional or local health care program operated
65	65	under Section 75.104, Health and Safety Code;
66	66	(12) a self-funded health benefit plan sponsored by a
67	67	professional employer organization under Chapter 91, Labor Code;
68	68	(13) county employee group health benefits provided
69	69	under Chapter 157, Local Government Code;
70	70	(14) a health benefit plan offered by [(A) an approved
71	71	nonprofit health corporation that holds a certificate of authority
72	72	under Chapter 844; or
73	73	[(B)] an entity not authorized under this code or
74	74	another insurance law of this state that contracts directly for
75	75	health care services on a risk-sharing basis, including a
76	76	capitation basis; and [or]
77	77	(15) [(3) provides] health and accident coverage
78	78	provided through a risk pool created under Chapter 172, Local
79	79	Government Code[, notwithstanding Section 172.014, Local
80	80	Government Code, or any other law].
81	81	SECTION 2. Section 1362.002, Insurance Code, is amended to
82	82	read as follows:
83	83	Sec. 1362.002. EXCEPTION. This chapter does not apply to:
84	84	(1) a health benefit plan that provides coverage:
85	85	(A) only for a specified disease or for another
86	86	limited benefit;
87	87	(B) only for accidental death or dismemberment;
88	88	(C) for wages or payments in lieu of wages for a
89	89	period during which an employee is absent from work because of
90	90	sickness or injury;
91	91	(D) as a supplement to a liability insurance
92	92	policy; or
93	93	(E) only for indemnity for hospital confinement;
94	94	(2) [a small employer health benefit plan written
95	95	under Chapter 1501;
96	96	[(3)] a Medicare supplemental policy as defined by
97	97	Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
98	98	(3) [(4)] a workers' compensation insurance policy;
99	99	(4) [(5)] medical payment insurance coverage provided
100	100	under a motor vehicle insurance policy; or
101	101	(5) [(6)] a long-term care insurance policy,
102	102	including a nursing home fixed indemnity policy, unless the
103	103	commissioner determines that the policy provides benefit coverage
104	104	so comprehensive that the policy is a health benefit plan as
105	105	described by Section 1362.001.
106	106	SECTION 3. Section 1362.003, Insurance Code, is amended by
107	107	adding Subsections (c) and (d) to read as follows:
108	108	(c) A health benefit plan that provides coverage under this
109	109	section may not charge any premium, copayment, coinsurance,
110	110	deductible, or any other form of cost sharing for a covered benefit
111	111	described by this section.
112	112	(d) Subsection (c) does not apply to a qualified health plan
113	113	if a determination is made under 45 C.F.R. Section 155.170 that:
114	114	(1) that subsection requires the plan to offer
115	115	benefits in addition to the essential health benefits required
116	116	under 42 U.S.C. Section 18022(b); and
117	117	(2) this state is required to defray the cost of the
118	118	benefits mandated under that subsection.
119	119	SECTION 4. Section 1575.159, Insurance Code, is repealed.
120	120	SECTION 5. If before implementing any provision of this Act
121	121	a state agency determines that a waiver or authorization from a
122	122	federal agency is necessary for implementation of that provision,
123	123	the agency affected by the provision shall request the waiver or
124	124	authorization and may delay implementing that provision until the
125	125	waiver or authorization is granted.
126	126	SECTION 6. The changes in law made by this Act apply only to
127	127	a health benefit plan delivered, issued for delivery, or renewed on
128	128	or after January 1, 2022. A health benefit plan delivered, issued
129	129	for delivery, or renewed before January 1, 2022, is governed by the
130	130	law as it existed immediately before the effective date of this Act,
131	131	and that law is continued in effect for that purpose.
132	132	SECTION 7. This Act takes effect September 1, 2021.