CHAPTER 1362. CERTAIN TESTS FOR DETECTION OF PROSTATE CANCER
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES
CHAPTER 1362. CERTAIN TESTS FOR DETECTION OF PROSTATE CANCER
Sec. 1362.001. 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 stipulated premium company operating under Chapter 884;
or
(v) 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:
(A) an approved nonprofit health corporation that holds a
certificate of authority under Chapter 844; or
(B) an entity not authorized under this code or another
insurance law of this state that contracts directly for health
care services on a risk-sharing basis, including a capitation
basis; 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, Sec. 3, eff. April 1,
2005.
Sec. 1362.002. EXCEPTION. This chapter does not apply to:
(1) a health benefit plan that provides coverage:
(A) only for a specified disease or for another 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);
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under a motor
vehicle insurance policy; or
(6) 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 1362.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1362.003. COVERAGE REQUIRED. (a) A health benefit plan
that provides coverage for diagnostic medical procedures must
provide to each male enrolled in the plan coverage for expenses
for an annual medically recognized diagnostic examination for the
detection of prostate cancer.
(b) Coverage required under this section includes at a minimum:
(1) a physical examination for the detection of prostate cancer;
and
(2) a prostate-specific antigen test used for the detection of
prostate cancer for each male who:
(A) is at least 50 years of age and is asymptomatic; or
(B) is at least 40 years of age and has a family history of
prostate cancer or another prostate cancer risk factor.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1362.004. 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, Sec. 3, eff. April 1,
2005.
Sec. 1362.005. RULES. The commissioner shall adopt rules
necessary to administer this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.