85R8019 PMO-D
  By: Menéndez S.B. No. 756
  relating to required coverage for obesity under group health
  benefit plans.
         SECTION 1.  Subtitle E, Title 8, Insurance Code, is amended
  by adding Chapter 1372 to read as follows:
         Sec. 1372.001.  APPLICABILITY OF CHAPTER. (a) This chapter
  applies only to a group health benefit plan that provides benefits
  for medical or surgical expenses incurred as a result of a health
  condition, accident, or sickness, including a group insurance
  policy, group insurance agreement, group hospital service
  contract, 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 health maintenance organization operating under
  Chapter 843;
               (4)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846;
               (5)  a stipulated premium company operating under
  Chapter 884; or
               (6)  a fraternal benefit society operating under
  Chapter 885.
         (b)  Notwithstanding any other law, this chapter applies to
  group coverage provided through a small employer health benefit
  plan subject to Chapter 1501, including group coverage provided
  through a health group cooperative under Subchapter B of that
         Sec. 1372.002.  CONDITIONAL EXCEPTION. This chapter does
  not apply to a qualified health plan if a determination is made
  under 45 C.F.R. Section 155.170 that:
               (1)  this chapter requires the plan to offer benefits
  in addition to the essential health benefits required under 42
  U.S.C. Section 18022(b); and
               (2)  this state is required to defray the cost of the
  benefits mandated under this chapter.
         Sec. 1372.003.  REQUIRED COVERAGE FOR OBESITY. (a) A group
  health benefit plan must provide coverage, based on medical
  necessity, for the diagnosis and treatment of obesity.
         (b)  Coverage required under Subsection (a) is limited to a
  service, including bariatric surgery and nutritional counseling
  and therapy, or a medication, to the extent the group health benefit
  plan provides pharmacy benefits, ordered by a licensed physician,
  psychiatrist, psychologist, or therapist within the scope of the
  practitioner's license and in accordance with a treatment plan.
         (c)  On request from the group health benefit plan issuer, an
  obesity treatment plan must include all elements necessary for the
  issuer to pay a claim under the group health benefit plan, which may
  include a diagnosis, goals, and proposed treatment by type,
  frequency, and duration.
         SECTION 2.  Not later than November 1 of each even-numbered
  year, the comptroller of public accounts shall prepare and submit
  to the legislature a biennial report on the human and financial cost
  of obesity in this state. This section expires December 1, 2020.
         SECTION 3.  The changes in law made by this Act apply only to
  a group health benefit plan delivered, issued for delivery, or
  renewed on or after January 1, 2018.
         SECTION 4.  This Act takes effect September 1, 2017.