Bill Text: TX HB3984 | 2019-2020 | 86th Legislature | Engrossed
Bill Title: Relating to health benefit plan coverage for scalp cooling for cancer patients.
Spectrum: Partisan Bill (Republican 1-0)
Status: (Engrossed - Dead) 2019-05-13 - Referred to Business & Commerce [HB3984 Detail]
Download: Texas-2019-HB3984-Engrossed.html
By: Leach | H.B. No. 3984 |
|
||
|
||
relating to health benefit plan coverage for scalp cooling for | ||
cancer patients. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended | ||
by adding Chapter 1380 to read as follows: | ||
CHAPTER 1380. COVERAGE FOR SCALP COOLING SYSTEMS, APPLICATIONS AND | ||
PROCEDURES FOR CANCER PATIENTS | ||
Sec. 1380.001. DEFINITIONS. In this chapter: | ||
(1) "Enrollee" means an individual entitled to | ||
coverage under a health benefit plan. | ||
(2) "Scalp Cooling" means a system, application or | ||
procedure cleared for use by the United States Food and Drug | ||
Administration with the purpose of reducing hair loss in certain | ||
individuals undergoing chemotherapy treatment. | ||
Sec. 1380.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
applies only to a health benefit plan, including a small employer | ||
health benefit plan written under Chapter 1501 or coverage provided | ||
by a health group cooperative under Subchapter B of that chapter, | ||
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) a reciprocal exchange operating under Chapter 942; | ||
(6) a Lloyd's plan operating under Chapter 941; | ||
(7) a health maintenance organization operating under | ||
Chapter 843; | ||
(8) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; or | ||
(9) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844. | ||
(b) Notwithstanding any provision in Chapter 1551, 1575, | ||
1579, or 1601 or any other law, this chapter applies to: | ||
(1) a basic coverage plan under Chapter 1551; | ||
(2) a basic plan under Chapter 1575; | ||
(3) a primary care coverage plan under Chapter 1579; | ||
and | ||
(4) basic coverage under Chapter 1601. | ||
Sec. 1380.003. REQUIRED COVERAGE FOR SCALP COOLING SYSTEMS, | ||
APPLICATIONS AND PROCEDURES FOR CERTAIN CANCER PATIENTS. (a) A | ||
health benefit plan must provide coverage for: | ||
(1) scalp cooling systems, applications and | ||
procedures: | ||
(a) for an enrollee who is undergoing or has | ||
undergone medical treatment for cancer; and | ||
(b) determined by the enrollee's treating | ||
physician to be appropriate for the enrollee in connection with the | ||
side effects of the treatment, if any, described by Paragraph (a). | ||
(c) An additional premium may not be charged for | ||
the coverage required by Subsection (a). | ||
(d) Coverage required under Subsection (a) may be | ||
subject to the annual deductibles, copayments, and coinsurance that | ||
are consistent with annual deductibles, copayments, and | ||
coinsurance for other coverage under the health benefit plan. | ||
(b) Coverage required under this section: | ||
(1) must be provided in a manner determined to be | ||
appropriate in consultation with the treating physician, as | ||
applicable, and the enrollee; | ||
(2) may be subject to annual deductibles, copayments, | ||
and coinsurance that are consistent with annual deductibles, | ||
copayments, and coinsurance required for other coverage under the | ||
health benefit plan; and | ||
(3) may not be subject to annual dollar limits. | ||
Sec. 1380.004. PREAUTHORIZATION. A health benefit plan may | ||
require prior authorization for a scalp cooling system, application | ||
or procedure in the same manner that the health benefit plan | ||
requires prior authorization for any other covered benefit. | ||
Sec. 1380.005. CONDITIONAL EXCEPTION. This subchapter does | ||
not apply to a qualified health plan if a determination is made | ||
under 45 C.F.R. Section 155.170 that: | ||
(1) this subchapter 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 subchapter. | ||
SECTION 2. Chapter 1380, Insurance Code, as added by this | ||
Act, applies only to a health benefit plan that is delivered, issued | ||
for delivery, or renewed on or after January 1, 2010. A health | ||
benefit plan that is delivered, issued for delivery, or renewed | ||
before January 1, 2010, is covered by the law in effect at the time | ||
the plan was delivered, issued for delivery, or renewed, and that | ||
law is continued in effect for that purpose. | ||
SECTION 3. This Act takes effect September 1, 2019. |