| 1 | 1 | | 88R14056 CJD-D |
|---|
| 2 | 2 | | By: Bucy H.B. No. 3767 |
|---|
| 3 | 3 | | |
|---|
| 4 | 4 | | |
|---|
| 5 | 5 | | A BILL TO BE ENTITLED |
|---|
| 6 | 6 | | AN ACT |
|---|
| 7 | 7 | | relating to health benefit coverage for diagnostic examinations for |
|---|
| 8 | 8 | | lung cancer. |
|---|
| 9 | 9 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|---|
| 10 | 10 | | SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
|---|
| 11 | 11 | | by adding Chapter 1372 to read as follows: |
|---|
| 12 | 12 | | CHAPTER 1372. CERTAIN TESTS FOR DETECTION OF LUNG CANCER |
|---|
| 13 | 13 | | Sec. 1372.001. APPLICABILITY OF CHAPTER. (a) This chapter |
|---|
| 14 | 14 | | applies only to a health benefit plan that provides benefits for |
|---|
| 15 | 15 | | medical or surgical expenses incurred as a result of a health |
|---|
| 16 | 16 | | condition, accident, or sickness, including an individual, group, |
|---|
| 17 | 17 | | blanket, or franchise insurance policy or insurance agreement, a |
|---|
| 18 | 18 | | group hospital service contract, an individual or group evidence of |
|---|
| 19 | 19 | | coverage, or a similar coverage document, that is offered by: |
|---|
| 20 | 20 | | (1) an insurance company; |
|---|
| 21 | 21 | | (2) a group hospital service corporation operating |
|---|
| 22 | 22 | | under Chapter 842; |
|---|
| 23 | 23 | | (3) a health maintenance organization operating under |
|---|
| 24 | 24 | | Chapter 843; |
|---|
| 25 | 25 | | (4) an approved nonprofit health corporation that |
|---|
| 26 | 26 | | holds a certificate of authority under Chapter 844; |
|---|
| 27 | 27 | | (5) a multiple employer welfare arrangement that holds |
|---|
| 28 | 28 | | a certificate of authority under Chapter 846; |
|---|
| 29 | 29 | | (6) a stipulated premium company operating under |
|---|
| 30 | 30 | | Chapter 884; |
|---|
| 31 | 31 | | (7) a fraternal benefit society operating under |
|---|
| 32 | 32 | | Chapter 885; |
|---|
| 33 | 33 | | (8) a Lloyd's plan operating under Chapter 941; or |
|---|
| 34 | 34 | | (9) a reciprocal exchange operating under Chapter 942. |
|---|
| 35 | 35 | | (b) This chapter applies to a small employer health benefit |
|---|
| 36 | 36 | | plan written under Chapter 1501. |
|---|
| 37 | 37 | | Sec. 1372.002. EXCEPTIONS. This chapter does not apply to: |
|---|
| 38 | 38 | | (1) a plan that provides coverage: |
|---|
| 39 | 39 | | (A) only for benefits for a specified disease or |
|---|
| 40 | 40 | | for another limited benefit, other than a plan that provides |
|---|
| 41 | 41 | | benefits for cancer treatment or similar services; |
|---|
| 42 | 42 | | (B) only for accidental death or dismemberment; |
|---|
| 43 | 43 | | (C) for wages or payments in lieu of wages for a |
|---|
| 44 | 44 | | period during which an employee is absent from work because of |
|---|
| 45 | 45 | | sickness or injury; |
|---|
| 46 | 46 | | (D) as a supplement to a liability insurance |
|---|
| 47 | 47 | | policy; |
|---|
| 48 | 48 | | (E) only for dental or vision care; or |
|---|
| 49 | 49 | | (F) only for indemnity for hospital confinement; |
|---|
| 50 | 50 | | (2) a Medicare supplemental policy as defined by |
|---|
| 51 | 51 | | Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
|---|
| 52 | 52 | | (3) the state Medicaid program, including the Medicaid |
|---|
| 53 | 53 | | managed care program operated under Chapter 533, Government Code; |
|---|
| 54 | 54 | | (4) the child health plan program under Chapter 62, |
|---|
| 55 | 55 | | Health and Safety Code; |
|---|
| 56 | 56 | | (5) a workers' compensation insurance policy; |
|---|
| 57 | 57 | | (6) medical payment insurance coverage provided under |
|---|
| 58 | 58 | | an automobile insurance policy; |
|---|
| 59 | 59 | | (7) a credit insurance policy; |
|---|
| 60 | 60 | | (8) a limited benefit policy that does not provide |
|---|
| 61 | 61 | | coverage for physical examinations or wellness exams; or |
|---|
| 62 | 62 | | (9) a long-term care insurance policy, including a |
|---|
| 63 | 63 | | nursing home fixed indemnity policy, unless the commissioner |
|---|
| 64 | 64 | | determines that the policy provides benefit coverage so |
|---|
| 65 | 65 | | comprehensive that the policy is a health benefit plan as described |
|---|
| 66 | 66 | | by Section 1370.001. |
|---|
| 67 | 67 | | Sec. 1372.003. COVERAGE REQUIRED. (a) A health benefit |
|---|
| 68 | 68 | | plan that provides coverage for diagnostic medical procedures must |
|---|
| 69 | 69 | | provide coverage for an annual medically recognized examination for |
|---|
| 70 | 70 | | the early detection of lung cancer to each person enrolled in the |
|---|
| 71 | 71 | | plan who is at least 50 years of age and: |
|---|
| 72 | 72 | | (1) is a current or former smoker; or |
|---|
| 73 | 73 | | (2) has: |
|---|
| 74 | 74 | | (A) a personal or family history of lung cancer; |
|---|
| 75 | 75 | | (B) a genetic risk factor associated with lung |
|---|
| 76 | 76 | | cancer; |
|---|
| 77 | 77 | | (C) been exposed to environmental or |
|---|
| 78 | 78 | | occupational carcinogens; or |
|---|
| 79 | 79 | | (D) been exposed to therapeutic radiation. |
|---|
| 80 | 80 | | (b) A diagnostic examination required under this section |
|---|
| 81 | 81 | | must be performed in accordance with the guidelines adopted by: |
|---|
| 82 | 82 | | (1) the American Lung Association; or |
|---|
| 83 | 83 | | (2) another similar national organization of medical |
|---|
| 84 | 84 | | professionals recognized by the commissioner. |
|---|
| 85 | 85 | | Sec. 1372.004. NOTICE OF COVERAGE. (a) A health benefit |
|---|
| 86 | 86 | | plan issuer shall provide to each person enrolled in the plan |
|---|
| 87 | 87 | | written notice of the coverage required under this chapter. |
|---|
| 88 | 88 | | (b) The notice must be provided in accordance with rules |
|---|
| 89 | 89 | | adopted by the commissioner. |
|---|
| 90 | 90 | | SECTION 2. The change in law made by this Act applies only |
|---|
| 91 | 91 | | to a health benefit plan that is delivered, issued for delivery, or |
|---|
| 92 | 92 | | renewed on or after January 1, 2024. |
|---|
| 93 | 93 | | SECTION 3. This Act takes effect September 1, 2023. |
|---|