Texas 2025 - 89th Regular

Texas Senate Bill SB1955 Compare Versions

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

Old	New	Differences
1	1	89R17290 TYPED
2	2	By: Parker S.B. No. 1955
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7	7	A BILL TO BE ENTITLED
8	8	AN ACT
9	9	relating to health benefit plan coverage for cancer screening,
10	10	imaging, and genetic testing.
11	11	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
12	12	SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
13	13	by adding Chapter 1373 to read as follows:
14	14	CHAPTER 1373. COVERAGE FOR CANCER SCREENING, IMAGING, AND GENETIC
15	15	TESTING
16	16	Sec. 1373.001. DEFINITION. In this chapter, "nationally
17	17	recognized clinical practice guidelines" means evidence-based
18	18	clinical practice guidelines that:
19	19	(1) establish a standard of care informed by a
20	20	systematic review of evidence and an assessment of the benefits and
21	21	costs of alternative care options;
22	22	(2) include recommendations intended to optimize
23	23	patient care; and
24	24	(3) are developed by an independent organization or
25	25	medical professional society that uses a transparent methodology
26	26	and reporting structure and is subject to a conflict of interest
27	27	policy.
28	28	Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This chapter
29	29	applies only to a health benefit plan that provides benefits for
30	30	medical or surgical expenses incurred as a result of a health
31	31	condition, accident, or sickness, including an individual, group,
32	32	blanket, or franchise insurance policy or insurance agreement, a
33	33	group hospital service contract, or an individual or group contract
34	34	or similar coverage document that is issued by:
35	35	(1) an insurance company;
36	36	(2) a group hospital service corporation operating
37	37	under Chapter 842;
38	38	(3) a health maintenance organization operating under
39	39	Chapter 843;
40	40	(4) an approved nonprofit health corporation that
41	41	holds a certificate of authority under Chapter 844;
42	42	(5) a multiple employer welfare arrangement that holds
43	43	a certificate of authority under Chapter 846;
44	44	(6) a stipulated premium company operating under
45	45	Chapter 884;
46	46	(7) a fraternal benefit society operating under
47	47	Chapter 885;
48	48	(8) a Lloyd's plan operating under Chapter 941; or
49	49	(9) a reciprocal exchange operating under Chapter 942.
50	50	(b) Notwithstanding any other law, this chapter applies to:
51	51	(1) a small employer health benefit plan subject to
52	52	Chapter 1501, including coverage provided through a health group
53	53	cooperative under Subchapter B of that chapter;
54	54	(2) a standard health benefit plan issued under
55	55	Chapter 1507;
56	56	(3) a basic coverage plan under Chapter 1551;
57	57	(4) a basic plan under Chapter 1575;
58	58	(5) a primary care coverage plan under Chapter 1579;
59	59	and
60	60	(6) a plan providing basic coverage under Chapter
61	61	1601.
62	62	Sec. 1373.003. COVERAGE FOR CANCER SCREENING AND IMAGING.
63	63	A health benefit plan must provide coverage for preventive cancer
64	64	screening and imaging for enrollees who have an increased risk of
65	65	developing cancer if the screening or imaging is:
66	66	(1) ordered by a health care provider; and
67	67	(2) supported by nationally recognized clinical
68	68	practice guidelines.
69	69	Sec. 1373.004. COVERAGE FOR GENETIC TESTING. A health
70	70	benefit plan must provide coverage for germline testing for an
71	71	inherited mutation associated with an increased risk of cancer.
72	72	if the testing is:
73	73	(1) ordered by a health care provider; and
74	74	(2) supported by nationally recognized clinical
75	75	practice guidelines.
76	76	Sec. 1373.005. COPAYMENT, DEDUCTIBLE, OR COINSURANCE
77	77	REQUIREMENT PROHIBITED. (a) Coverage required under this chapter
78	78	may not be made subject to a deductible, copayment, or coinsurance
79	79	requirement.
80	80	(b) Notwithstanding Subsection (a), if not subjecting an
81	81	enrollee to a deductible for genetic testing or cancer screening or
82	82	imaging under this chapter would cause an enrollee enrolled in a
83	83	high deductible health plan, as that term is defined by Section 223,
84	84	Internal Revenue Code of 1986, who has established a health savings
85	85	account under that section, to become ineligible for that plan, a
86	86	health benefit plan issuer shall waive the deductible only after
87	87	the enrollee has satisfied the minimum deductible under the plan,
88	88	except with respect to preventive care services for which the
89	89	enrollee is not required to meet a deductible in accordance with
90	90	Section 223(c)(2)(C), Internal Revenue Code of 1986.
91	91	SECTION 2. Chapter 1373, Insurance Code, as added by this
92	92	Act, applies only to a health benefit plan delivered, issued for
93	93	delivery, or renewed on or after January 1, 2026.
94	94	SECTION 3. This Act takes effect September 1, 2025.