89R17290 TYPED
By: Parker S.B. No. 1955
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for cancer screening,
imaging, and genetic testing.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1373 to read as follows:
CHAPTER 1373. COVERAGE FOR CANCER SCREENING, IMAGING, AND GENETIC
TESTING
Sec. 1373.001. DEFINITION. In this chapter, "nationally
recognized clinical practice guidelines" means evidence-based
clinical practice guidelines that:
(1) establish a standard of care informed by a
systematic review of evidence and an assessment of the benefits and
costs of alternative care options;
(2) include recommendations intended to optimize
patient care; and
(3) are developed by an independent organization or
medical professional society that uses a transparent methodology
and reporting structure and is subject to a conflict of interest
policy.
Sec. 1373.002. 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, or an individual or group contract
or similar coverage document that is issued 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) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
and
(6) a plan providing basic coverage under Chapter
1601.
Sec. 1373.003. COVERAGE FOR CANCER SCREENING AND IMAGING.
A health benefit plan must provide coverage for preventive cancer
screening and imaging for enrollees who have an increased risk of
developing cancer if the screening or imaging is:
(1) ordered by a health care provider; and
(2) supported by nationally recognized clinical
practice guidelines.
Sec. 1373.004. COVERAGE FOR GENETIC TESTING. A health
benefit plan must provide coverage for germline testing for an
inherited mutation associated with an increased risk of cancer.
if the testing is:
(1) ordered by a health care provider; and
(2) supported by nationally recognized clinical
practice guidelines.
Sec. 1373.005. COPAYMENT, DEDUCTIBLE, OR COINSURANCE
REQUIREMENT PROHIBITED. (a) Coverage required under this chapter
may not be made subject to a deductible, copayment, or coinsurance
requirement.
(b) Notwithstanding Subsection (a), if not subjecting an
enrollee to a deductible for genetic testing or cancer screening or
imaging under this chapter would cause an enrollee enrolled in a
high deductible health plan, as that term is defined by Section 223,
Internal Revenue Code of 1986, who has established a health savings
account under that section, to become ineligible for that plan, a
health benefit plan issuer shall waive the deductible only after
the enrollee has satisfied the minimum deductible under the plan,
except with respect to preventive care services for which the
enrollee is not required to meet a deductible in accordance with
Section 223(c)(2)(C), Internal Revenue Code of 1986.
SECTION 2. Chapter 1373, Insurance Code, as added by this
Act, applies only to a health benefit plan delivered, issued for
delivery, or renewed on or after January 1, 2026.
SECTION 3. This Act takes effect September 1, 2025.