| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to coverage for supplemental breast cancer screening under |
|
|
certain health benefit plans. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. This Act shall be known as Henda's Law. |
|
|
SECTION 2. Section 1201.005, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1201.005. REFERENCES TO CHAPTER. In this chapter, a |
|
|
reference to this chapter includes a reference to: |
|
|
(1) Section 1202.052; |
|
|
(2) Section 1271.005(a), to the extent that the |
|
|
subsection relates to the applicability of Section 1201.105, and |
|
|
Sections 1271.005(d) and (e); |
|
|
(3) Chapter 1351; |
|
|
(4) Subchapters C and E, Chapter 1355; |
|
|
(5) Subchapter A, Chapter 1356; |
|
|
(6) Chapter 1365; |
|
|
(7) Subchapter A, Chapter 1367; and |
|
|
(8) Subchapters A, B, and G, Chapter 1451. |
|
|
SECTION 3. The heading to Chapter 1356, Insurance Code, is |
|
|
amended to read as follows: |
|
|
CHAPTER 1356. [LOW-DOSE] MAMMOGRAPHY AND OTHER BREAST CANCER |
|
|
SCREENING |
|
|
SECTION 4. Sections 1356.001 through 1356.005, Insurance |
|
|
Code, are designated as Subchapter A, Chapter 1356, Insurance Code, |
|
|
and a heading is added to Subchapter A to read as follows: |
|
|
SUBCHAPTER A. LOW-DOSE MAMMOGRAPHY |
|
|
SECTION 5. Section 1356.001, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1356.001. DEFINITION. In this subchapter [chapter], |
|
|
"low-dose mammography" means the x-ray examination of the breast |
|
|
using equipment dedicated specifically for mammography, including |
|
|
an x-ray tube, filter, compression device, screens, films, and |
|
|
cassettes, with an average radiation exposure delivery of less than |
|
|
one rad mid-breast, with two views for each breast. |
|
|
SECTION 6. Section 1356.002, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1356.002. APPLICABILITY OF SUBCHAPTER [CHAPTER]. This |
|
|
subchapter [chapter] applies only to a health benefit plan that is |
|
|
delivered, issued for delivery, or renewed in this state and that is |
|
|
an individual or group accident and health insurance policy, |
|
|
including a policy issued by a group hospital service corporation |
|
|
operating under Chapter 842. |
|
|
SECTION 7. Section 1356.003, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1356.003. APPLICABILITY OF GENERAL PROVISIONS OF OTHER |
|
|
LAW. The provisions of Chapter 1201, including provisions relating |
|
|
to the applicability, purpose, and enforcement of that chapter, |
|
|
construction of policies under that chapter, rulemaking under that |
|
|
chapter, and definitions of terms applicable in that chapter, apply |
|
|
to this subchapter [chapter]. |
|
|
SECTION 8. Section 1356.004, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1356.004. EXCEPTION. This subchapter [chapter] does |
|
|
not apply to a plan that provides coverage only for a specified |
|
|
disease or for another limited benefit. |
|
|
SECTION 9. Chapter 1356, Insurance Code, is amended by |
|
|
adding Subchapter B to read as follows: |
|
|
SUBCHAPTER B. SUPPLEMENTAL BREAST CANCER SCREENING |
|
|
Sec. 1356.051. DEFINITIONS. In this subchapter: |
|
|
(1) "Health benefit exchange" means an American Health |
|
|
Benefit Exchange administered by the federal government or created |
|
|
under Section 1311(b), Patient Protection and Affordable Care Act |
|
|
(42 U.S.C. Section 18031). |
|
|
(2) "Qualified health plan" has the meaning assigned |
|
|
by Section 1301(a), Patient Protection and Affordable Care Act (42 |
|
|
U.S.C. Section 18021). |
|
|
(3) "Supplemental breast cancer screening" means a |
|
|
method of screening, including ultrasound imaging, that is designed |
|
|
to supplement mammography by detecting breast cancers that may not |
|
|
be visible using only mammography. |
|
|
Sec. 1356.052. APPLICABILITY OF SUBCHAPTER. (a) This |
|
|
subchapter 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 evidence of coverage or similar coverage document that is |
|
|
offered by: |
|
|
(1) an insurance company; |
|
|
(2) a group hospital service corporation operating |
|
|
under Chapter 842; |
|
|
(3) a fraternal benefit society operating under |
|
|
Chapter 885; |
|
|
(4) a stipulated premium company operating under |
|
|
Chapter 884; |
|
|
(5) an exchange operating under Chapter 942; |
|
|
(6) a health maintenance organization operating under |
|
|
Chapter 843; or |
|
|
(7) an approved nonprofit health corporation that |
|
|
holds a certificate of authority under Chapter 844. |
|
|
(b) Notwithstanding Section 1501.251 or any other law, this |
|
|
subchapter applies to coverage under a small employer health |
|
|
benefit plan subject to Chapter 1501. |
|
|
Sec. 1356.053. EXCEPTION. This subchapter does not apply |
|
|
to: |
|
|
(1) a plan that provides coverage: |
|
|
(A) only for benefits for a specified disease or |
|
|
for another limited benefit; |
|
|
(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) for credit insurance; |
|
|
(F) only for dental or vision care; |
|
|
(G) only for hospital expenses; or |
|
|
(H) 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) a workers' compensation insurance policy; |
|
|
(4) medical payment insurance coverage provided under |
|
|
a motor vehicle insurance policy; |
|
|
(5) a long-term care 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 1356.052; or |
|
|
(6) a qualified health plan offered through a health |
|
|
benefit exchange. |
|
|
Sec. 1356.054. OFFER OF OPTIONAL COVERAGE REQUIRED. (a) An |
|
|
issuer of a health benefit plan that provides coverage for |
|
|
mammography, including coverage for low-dose mammography required |
|
|
by Subchapter A, must also offer to provide coverage for |
|
|
supplemental breast cancer screening as part of an annual |
|
|
well-woman examination covered under the plan if a licensed health |
|
|
care professional treating the enrollee or screening the enrollee |
|
|
for breast cancer finds that the enrollee has: |
|
|
(1) dense breast tissue, as defined by the Breast |
|
|
Imaging Reporting and Database System (Fourth Edition) established |
|
|
by the American College of Radiology; and |
|
|
(2) additional risk factors determined under |
|
|
Subsection (c) for breast cancer that warrant supplemental breast |
|
|
cancer screening beyond mammography. |
|
|
(b) An additional premium may be charged for the coverage |
|
|
described by Subsection (a). |
|
|
(c) The commissioner by rule shall determine risk factors |
|
|
described by Subsection (a)(2) based on scientific research and |
|
|
models for breast cancer. |
|
|
SECTION 10. This Act applies only to a health benefit plan |
|
|
that is delivered, issued for delivery, or renewed on or after |
|
|
January 1, 2016. A health benefit plan that is delivered, issued |
|
|
for delivery, or renewed before January 1, 2016, is governed by the |
|
|
law as it existed immediately before the effective date of this Act, |
|
|
and that law is continued in effect for that purpose. |
|
|
SECTION 11. This Act takes effect September 1, 2015. |