HBA-TYH H.B. 859 76(R) BILL ANALYSIS Office of House Bill AnalysisH.B. 859 By: Dukes Insurance 3/2/1999 Introduced BACKGROUND AND PURPOSE Currently, health insurance plans may cut services critical to women's health such as diagnostic screenings and preventive maintenance checkups because they are relatively expensive for insurers to cover. H.B. 859 requires an insurance company to maintain the same deductible and copayment for treatment of any type of cancer, which prevents the companies from imposing higher fees for breast cancer treatments than are imposed on treatments for other types of cancer. It also prohibits a plan from imposing a deductible, coinsurance, or copayment on certain screenings and treatments vital to women's health, such as mammographies and cervical cytology. RULEMAKING AUTHORITY It is the opinion of the Office of House Bill Analysis that this bill does not expressly delegate any additional rulemaking authority to a state officer, department, agency, or institution. SECTION BY SECTION ANALYSIS SECTION 1. Amends Article 21.53C, Insurance Code, as follows: Sec. 1. New Title: DEFINITION. Amends the definition of "qualified individual" to include an individual who is estrogen deficient and at clinical risk for osteoporosis and an individual with a specific sign suggestive of spinal osteoporosis. Deletes the definition of "group health insurance policy." Makes conforming changes. Sec. 2. SCOPE OF ARTICLE. (a) Provides that this article applies only to a health benefit plan that: (1) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including: (A) an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group that is offered coverage by the enumerated entities; or (B) a health benefit plan that is offered by a multiple employer welfare arrangement as defined by Section 3, Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002) (Definitions), or another analogous benefit arrangement to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq. ) (Congressional Findings and Declaration of Policy); or (2) is offered by an approved nonprofit health corporation that is certified under Section 5.01(a), Medical Practice Act (Article 4495b, V.T.C.S.)(Medial Practice Act), and that holds a certificate of authority issued by the Commissioner of Insurance (commissioner) under Article 21.52F of this code (Certification of Certain Nonprofit Health Corporations). (b) Provides that this article does not apply to: (1) a plan that provides coverage only for a specified disease or other limited benefit, only for accidental death or dismemberment, for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury, as a supplement to liability insurance, or only for indemnity for hospital confinement or other hospital expenses; (2) a small employer health benefit plan written under Chapter 26 of this code (Health Insurance Availability); (3) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss) (Certification of Medicare Supplemental Health Insurance Policies); (4) workers' compensation insurance coverage; (5) medical payment insurance issued as part of a motor vehicle insurance policy; or (6) 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 Subsection (a) of this section. Sec. 3. New title: COVERAGE REQUIRED. Requires a group health insurance policy to provide, on the prescription of a health care provider, coverage for a qualified individual covered by the policy for medically accepted bone mass measurement and hormone replacement or other drug therapies. Makes conforming changes. SECTION 2. Amends Section 2(b), Article 21.53D, Insurance Code, as added by Chapter 84, Acts of the 75th Legislature, Regular Session, 1997, to include a plan that provides coverage for one type of cancer only, as identified by Texas Department of Insurance (department) rule, except for a plan covering breast cancer only, in a list of plans to which this article is not applicable. Makes conforming changes. SECTION 3. Amends Section 3, Article 21.53D, Insurance Code, as added by Chapter 84, Acts of the 75th Legislature, Regular Session, 1997, by adding Subsection (a) and creating Subsections (b) and (c) from existing text, as follows: Sec. 3. COVERAGE REQUIRED. Provides that a health benefit plan that provides coverage for any of the group of related diseases commonly known as cancer must provide coverage for treatment for breast cancer, including coverage for mastectomy and breast reconstruction. Authorizes the coverage required under Subsection (a) of this section to be subject to the same deductible or copayment applicable to coverage for any other type of cancer treatment. SECTION 4. Amends Article 21.53D, Insurance Code, as added by Chapter 912, Acts of the 75th Legislature, Regular Session, 1997, to redesignate it as Article 21.53H, as follows: Art. 21.53H. New title: CARE INVOLVING CERTAIN WOMEN'S HEALTH ISSUES. Sec. 2. SCOPE OF ARTICLE. Provides that Sections 3 and 4 of this article do not apply to any health benefit plan that does not provide pregnancy-related benefits, or any health benefit plan that does not provide well-woman care benefits. Redesignates Subsection (d) to (e). Makes conforming changes. Sec. 5. TREATMENT OF HORMONE DEFICIENCY. Requires a health benefit plan, on the prescription of a health care provider, to provide to a woman who is entitled to coverage under the plan coverage for hormone replacement therapy for the treatment of menopausal symptoms other than osteoporosis. Sec. 6. CERVICAL CYTOLOGY. Prohibits a health benefit plan from imposing a deductible, coinsurance, or a copayment specifically for a cervical cytology procedure. Sec. 7. ANNUAL MAMMOGRAPHY FOR CERTAIN ENROLLEES. Requires a health benefit plan to provide coverage for an annual mammogram for a woman who is entitled to coverage under the plan and who is at least 40 years of age. Prohibits a health benefit plan from imposing a deductible, coinsurance, or a copayment for services under this section. Sec. 8. NOTICE. Redesignates Section 5 to 8. Makes a conforming change. Sec. 9. RULES. Redesignates Section 6 to 9. Sec. 10. ADMINISTRATIVE PENALTY. Redesignates Section 7 to 10. SECTION 5. Effective date: September 1, 1999. Makes application of this Act prospective. SECTION 6. Emergency clause.