88R14056 CJD-D
By: Bucy H.B. No. 3767
A BILL TO BE ENTITLED
AN ACT
relating to health benefit coverage for diagnostic examinations for
lung cancer.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1372 to read as follows:
CHAPTER 1372. CERTAIN TESTS FOR DETECTION OF LUNG CANCER
Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter
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, an individual or group evidence of
coverage, or a similar coverage document, that is offered 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) a reciprocal exchange operating under Chapter 942.
(b) This chapter applies to a small employer health benefit
plan written under Chapter 1501.
Sec. 1372.002. EXCEPTIONS. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for benefits for a specified disease or
for another limited benefit, other than a plan that provides
benefits for cancer treatment or similar services;
(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;
(E) only for dental or vision care; 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);
(3) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 533, Government Code;
(4) the child health plan program under Chapter 62,
Health and Safety Code;
(5) a workers' compensation insurance policy;
(6) medical payment insurance coverage provided under
an automobile insurance policy;
(7) a credit insurance policy;
(8) a limited benefit policy that does not provide
coverage for physical examinations or wellness exams; or
(9) a long-term care insurance 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 1370.001.
Sec. 1372.003. COVERAGE REQUIRED. (a) A health benefit
plan that provides coverage for diagnostic medical procedures must
provide coverage for an annual medically recognized examination for
the early detection of lung cancer to each person enrolled in the
plan who is at least 50 years of age and:
(1) is a current or former smoker; or
(2) has:
(A) a personal or family history of lung cancer;
(B) a genetic risk factor associated with lung
cancer;
(C) been exposed to environmental or
occupational carcinogens; or
(D) been exposed to therapeutic radiation.
(b) A diagnostic examination required under this section
must be performed in accordance with the guidelines adopted by:
(1) the American Lung Association; or
(2) another similar national organization of medical
professionals recognized by the commissioner.
Sec. 1372.004. NOTICE OF COVERAGE. (a) A health benefit
plan issuer shall provide to each person enrolled in the plan
written notice of the coverage required under this chapter.
(b) The notice must be provided in accordance with rules
adopted by the commissioner.
SECTION 2. 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, 2024.
SECTION 3. This Act takes effect September 1, 2023.