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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for certain tests for the |
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early detection of cardiovascular disease. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1376 to read as follows: |
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CHAPTER 1376. CERTAIN TESTS FOR EARLY DETECTION OF CARDIOVASCULAR |
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DISEASE |
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Sec. 1376.001. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that: |
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(1) provides benefits for medical or surgical expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including: |
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(A) an individual, group, blanket, or franchise |
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insurance policy or insurance agreement, a group hospital service |
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contract, or an individual or group evidence of coverage that is |
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offered by: |
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(i) an insurance company; |
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(ii) a group hospital service corporation |
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operating under Chapter 842; |
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(iii) a fraternal benefit society operating |
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under Chapter 885; |
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(iv) a Lloyd's plan operating under Chapter |
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941; |
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(v) a stipulated premium company operating |
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under Chapter 884; or |
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(vi) a health maintenance organization |
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operating under Chapter 843; |
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(B) to the extent permitted by the Employee |
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Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et |
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seq.), a health benefit plan that is offered by: |
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(i) a multiple employer welfare arrangement |
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as defined by Section 3 of that Act (29 U.S.C. Section 1002); or |
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(ii) another analogous benefit |
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arrangement; |
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(C) a small employer health benefit plan written |
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under Chapter 1501; or |
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(D) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); |
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(2) is offered by an approved nonprofit health |
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corporation operating under Chapter 844; or |
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(3) provides health and accident coverage through a |
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risk pool created under Chapter 172, Local Government Code, |
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notwithstanding Section 172.014, Local Government Code. |
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(b) Notwithstanding any provision in Chapter 1601 or any |
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other law, this chapter applies to basic coverage under Chapter |
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1601. |
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Sec. 1376.002. EXCEPTIONS. This chapter does not apply to: |
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(1) a plan that provides coverage: |
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(A) only for a specified disease or other limited |
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benefit; |
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(B) only for accidental death or dismemberment; |
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(C) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(D) as a supplement to a liability insurance |
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policy; or |
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(E) only for indemnity for hospital confinement; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; or |
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(5) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides benefit coverage so comprehensive that the policy |
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is a health benefit plan as described by Section 1376.001. |
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Sec. 1376.003. MINIMUM COVERAGE REQUIRED. (a) A health |
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benefit plan that provides coverage for screening medical |
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procedures must provide the minimum coverage required by this |
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section to each covered individual: |
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(1) who is: |
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(A) a male older than 45 years of age and younger |
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than 76 years of age; or |
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(B) a female older than 55 years of age and |
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younger than 76 years of age; and |
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(2) who: |
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(A) is diabetic; or |
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(B) has a risk of developing coronary heart |
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disease, based on a score derived using the Framingham Heart Study |
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coronary prediction algorithm, that is intermediate or higher. |
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(b) The minimum coverage required to be provided under this |
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section is coverage of up to $200 for one of the following |
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noninvasive screening tests for atherosclerosis and abnormal |
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artery structure and function every five years, performed by a |
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laboratory that is certified by a national organization recognized |
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by the commissioner by rule for the purposes of this section: |
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(1) computed tomography (CT) scanning measuring |
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coronary artery calcification; or |
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(2) ultrasonography measuring carotid intima-media |
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thickness and plaque. |
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SECTION 2. The change in law made by this Act applies only |
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to a health benefit plan delivered, issued for delivery, or renewed |
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on or after January 1, 2010. A health benefit plan delivered, |
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issued for delivery, or renewed before January 1, 2010, is governed |
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by the law in effect immediately before the effective date of this |
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Act, and that law is continued in effect for that purpose. |
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SECTION 3. This Act takes effect September 1, 2009. |