plans must cover four or more at-home test kits monthly

The text as introduced · 529 words

89R3978 SCF-D

By: Bucy
H.B. No. 616

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for certain at-home

testing kits.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

SECTION 1. Subtitle E, Title 8, Insurance Code, is amended

by adding Chapter 1381 to read as follows:

CHAPTER 1381. COVERAGE FOR AT-HOME TESTING KITS

Sec. 1381.001. 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, or an individual or group evidence

of coverage or similar coverage document that is issued 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) an approved nonprofit health corporation that

holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds

a certificate of authority under Chapter 846;

(6) a stipulated premium company operating under

Chapter 884;

(7) a fraternal benefit society operating under

Chapter 885;

(8) a Lloyd's plan operating under Chapter 941; or

(9) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this chapter applies to:

(1) a small employer health benefit plan subject to

Chapter 1501, including coverage provided through a health group

cooperative under Subchapter B of that chapter;

(2) a standard health benefit plan issued under

Chapter 1507;

(3) a basic coverage plan under Chapter 1551;

(4) a basic plan under Chapter 1575;

(5) a primary care coverage plan under Chapter 1579;

(6) a plan providing basic coverage under Chapter

1601;

(7) the state Medicaid program, including the Medicaid

managed care program operated under Chapter 540, Government Code;

(8) the child health plan program under Chapter 62,

Health and Safety Code; and

(9) a self-funded health benefit plan sponsored by a

professional employer organization under Chapter 91, Labor Code.

Sec. 1381.002. COVERAGE REQUIRED FOR CERTAIN AT-HOME

TESTING KITS. (a) A health benefit plan must provide coverage in

accordance with this section for an at-home testing kit that tests

for:

(1) coronavirus, influenza, or both coronavirus and

influenza and is approved by the United States Food and Drug

Administration for that use; or

(2) a disease for which the kit has been approved by

the United States Food and Drug Administration for emergency use.

(b) A health benefit plan must provide coverage for at least

four kits described by Subsection (a) per enrollee per month.

SECTION 2. If before implementing any provision of this Act

a state agency determines that a waiver or authorization from a

federal agency is necessary for implementation of that provision,

the agency affected by the provision shall request the waiver or

authorization and may delay implementing that provision until the

waiver or authorization is granted.

SECTION 3. Chapter 1381, Insurance Code, as added by this

Act, applies only to a health benefit plan delivered, issued for

delivery, or renewed on or after January 1, 2026.

SECTION 4. This Act takes effect September 1, 2025.