bill requiring insurers to cover cancer screening and genetic testing

The text as introduced · 653 words

89R17290 TYPED

By: Parker
S.B. No. 1955

A BILL TO BE ENTITLED

AN ACT

relating to health benefit plan coverage for cancer screening,

imaging, and genetic testing.

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

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

by adding Chapter 1373 to read as follows:

CHAPTER 1373. COVERAGE FOR CANCER SCREENING, IMAGING, AND GENETIC

TESTING

Sec. 1373.001. DEFINITION. In this chapter, "nationally

recognized clinical practice guidelines" means evidence-based

clinical practice guidelines that:

(1) establish a standard of care informed by a

systematic review of evidence and an assessment of the benefits and

costs of alternative care options;

(2) include recommendations intended to optimize

patient care; and

(3) are developed by an independent organization or

medical professional society that uses a transparent methodology

and reporting structure and is subject to a conflict of interest

policy.

Sec. 1373.002. 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 contract

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) a reciprocal 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;

and

(6) a plan providing basic coverage under Chapter

1601.

Sec. 1373.003. COVERAGE FOR CANCER SCREENING AND IMAGING.

A health benefit plan must provide coverage for preventive cancer

screening and imaging for enrollees who have an increased risk of

developing cancer if the screening or imaging is:

(1) ordered by a health care provider; and

(2) supported by nationally recognized clinical

practice guidelines.

Sec. 1373.004. COVERAGE FOR GENETIC TESTING. A health

benefit plan must provide coverage for germline testing for an

inherited mutation associated with an increased risk of cancer.

if the testing is:

(1) ordered by a health care provider; and

(2) supported by nationally recognized clinical

practice guidelines.

Sec. 1373.005. COPAYMENT, DEDUCTIBLE, OR COINSURANCE

REQUIREMENT PROHIBITED. (a) Coverage required under this chapter

may not be made subject to a deductible, copayment, or coinsurance

requirement.

(b) Notwithstanding Subsection (a), if not subjecting an

enrollee to a deductible for genetic testing or cancer screening or

imaging under this chapter would cause an enrollee enrolled in a

high deductible health plan, as that term is defined by Section 223,

Internal Revenue Code of 1986, who has established a health savings

account under that section, to become ineligible for that plan, a

health benefit plan issuer shall waive the deductible only after

the enrollee has satisfied the minimum deductible under the plan,

except with respect to preventive care services for which the

enrollee is not required to meet a deductible in accordance with

Section 223(c)(2)(C), Internal Revenue Code of 1986.

SECTION 2. Chapter 1373, 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 3. This Act takes effect September 1, 2025.