2005 Texas Insurance Code CHAPTER 1363. CERTAIN TESTS FOR DETECTION OF COLORECTAL CANCER

INSURANCE CODE

CHAPTER 1363. CERTAIN TESTS FOR DETECTION OF COLORECTAL CANCER


	§ 1363.001. APPLICABILITY OF CHAPTER.  This chapter 
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 evidence of coverage that is 
offered by:
				(i)  an insurance company;                                                  
				(ii)  a group hospital service corporation 
operating under Chapter 842;   
				(iii)  a fraternal benefit society operating 
under Chapter 885;           
				(iv)  a Lloyd's plan operating under Chapter 
941;                         
				(v)  a stipulated premium company operating 
under Chapter 884;  or        
				(vi)  a health maintenance organization 
operating under Chapter 843;  and 
			(B)  to the extent permitted by the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 
seq.), a health benefit plan that is offered by:
				(i)  a multiple employer welfare arrangement 
as defined by Section 3 of that Act;  or
				(ii)  another analogous benefit 
arrangement;                              
		(2)  is offered by an approved nonprofit health 
corporation operating under Chapter 844;  or
		(3)  provides health and accident coverage through a 
risk pool created under Chapter 172, Local Government Code, 
notwithstanding Section 172.014, Local Government Code, or any 
other law.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1363.002. EXCEPTION.  This chapter does not apply to:                     
		(1)  a plan that provides coverage:                                           
			(A)  only for a specified disease or other limited 
benefit;                
			(B)  only for accidental death or dismemberment;                             
			(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;
			(D)  as a supplement to a liability insurance 
policy;  or                  
			(E)  only for indemnity for hospital confinement;                            
		(2)  a small employer health benefit plan written under 
Chapter 1501;       
		(3)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), 
as amended;
		(4)  a workers' compensation insurance policy;                                
		(5)  medical payment insurance coverage provided under 
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 Section 1363.001.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1363.003. MINIMUM COVERAGE REQUIRED.  (a) A health 
benefit plan that provides coverage for screening medical 
procedures must provide to each individual enrolled in the plan who 
is 50 years of age or older and at normal risk for developing colon 
cancer coverage for expenses incurred in conducting a medically 
recognized screening examination for the detection of colorectal 
cancer.
	(b)  The minimum coverage required under this section must 
include:          
		(1)  a fecal occult blood test performed annually and a 
flexible sigmoidoscopy performed every five years;  or
		(2)  a colonoscopy performed every 10 years.                                  

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1363.004. NOTICE OF COVERAGE.  (a) A health benefit 
plan issuer shall provide to each individual enrolled in the plan 
written notice of the coverage required under this chapter.
	(b)  The notice must be provided in accordance with rules 
adopted by the commissioner.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1363.005. RULES.  The commissioner shall adopt rules as 
necessary to administer this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.