1. Sec. 1370.001. APPLICABILITY OF CHAPTER. (a) This chapter 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, an individual or group evidence of coverage, or a similar coverage document, that is offered by:
    1. (1) an insurance company;
    2. (2) a group hospital service corporation operating under Chapter 842;
    3. (3) a fraternal benefit society operating under Chapter 885;
    4. (4) a stipulated premium company operating under Chapter 884;
    5. (5) a health maintenance organization operating under Chapter 843;
    6. (6) a reciprocal exchange operating under Chapter 942;
    7. (7) a Lloyd's plan operating under Chapter 941;
    8. (8) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or
    9. (9) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846.
  2. (b) This chapter applies to a small employer health benefit plan written under Chapter 1501.
  3. Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.
  1. Sec. 1370.002. EXCEPTIONS. (a) This chapter does not apply to:
    1. (1) a plan that provides coverage:
      1. (A) only for benefits for a specified disease or for another limited benefit, other than a plan that provides benefits for cancer treatment or similar services;
      2. (B) only for accidental death or dismemberment;
      3. (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;
      4. (D) as a supplement to a liability insurance policy;
      5. (E) only for dental or vision care; or
      6. (F) only for indemnity for hospital confinement;
    2. (2) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
    3. (3) a workers' compensation insurance policy;
    4. (4) medical payment insurance coverage provided under an automobile insurance policy;
    5. (5) a credit insurance policy;
    6. (6) a limited benefit policy that does not provide coverage for physical examinations or wellness exams; or
    7. (7) a long-term care insurance 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 1370.001.
  2. (b) To the extent that providing coverage for ovarian cancer screening under this chapter would otherwise require this state to make a payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 C.F.R. Section 155.20, is not required to provide a benefit for the ovarian cancer screening under this chapter that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).
  3. Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.
    Amended by:
    Acts 2015, 84th Leg., R.S., Ch. 176 (H.B. 2813), Sec. 2, eff. September 1, 2015.
  1. Sec. 1370.003. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for diagnostic medical procedures must provide to each woman 18 years of age or older enrolled in the plan coverage for expenses for an annual medically recognized diagnostic examination for the early detection of ovarian cancer and cervical cancer.
  2. (b) Coverage required under this section includes at a minimum:
    1. (1) a CA 125 blood test; and
    2. (2) a conventional Pap smear screening or a screening using liquid-based cytology methods, as approved by the United States Food and Drug Administration, alone or in combination with a test approved by the United States Food and Drug Administration for the detection of the human papillomavirus.
  3. (c) A screening test required under this section must be performed in accordance with the guidelines adopted by:
    1. (1) the American College of Obstetricians and Gynecologists; or
    2. (2) another similar national organization of medical professionals recognized by the commissioner.
    Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.
    Amended by:
    Acts 2015, 84th Leg., R.S., Ch. 176 (H.B. 2813), Sec. 3, eff. September 1, 2015.
  1. Sec. 1370.004. NOTICE OF COVERAGE. (a) A health benefit plan issuer shall provide to each woman 18 years of age or older enrolled in the plan written notice of the coverage required under this chapter.
  2. (b) The notice must be provided in accordance with rules adopted by the commissioner.
  3. Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.

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