CHAPTER 1376. CERTAIN TESTS FOR EARLY DETECTION OF CARDIOVASCULAR DISEASE
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES
CHAPTER 1376. CERTAIN TESTS FOR EARLY DETECTION OF CARDIOVASCULAR
DISEASE
Sec. 1376.001. APPLICABILITY OF CHAPTER. (a) 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;
(B) a health benefit plan that is offered by a multiple employer
welfare arrangement that holds a certificate of authority under
Chapter 846;
(C) a small employer health benefit plan written under Chapter
1501; or
(D) a Medicare supplemental policy as defined by Section
1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); or
(2) is offered by an approved nonprofit health corporation
operating under Chapter 844.
(b) Notwithstanding any provision in Chapter 1601 or any other
law, this chapter applies to basic coverage under Chapter 1601.
Added by Acts 2009, 81st Leg., R.S., Ch.
1270, Sec. 1, eff. September 1, 2009.
Sec. 1376.002. EXCEPTIONS. 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 standard health benefit plan issued under Chapter 1507;
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under a motor
vehicle insurance policy; or
(5) 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 1376.001.
Added by Acts 2009, 81st Leg., R.S., Ch.
1270, Sec. 1, eff. September 1, 2009.
Sec. 1376.003. MINIMUM COVERAGE REQUIRED. (a) A health benefit
plan that provides coverage for screening medical procedures must
provide the minimum coverage required by this section to each
covered individual:
(1) who is:
(A) a male older than 45 years of age and younger than 76 years
of age; or
(B) a female older than 55 years of age and younger than 76
years of age; and
(2) who:
(A) is diabetic; or
(B) has a risk of developing coronary heart disease, based on a
score derived using the Framingham Heart Study coronary
prediction algorithm, that is intermediate or higher.
(b) The minimum coverage required to be provided under this
section is coverage of up to $200 for one of the following
noninvasive screening tests for atherosclerosis and abnormal
artery structure and function every five years, performed by a
laboratory that is certified by a national organization
recognized by the commissioner by rule for the purposes of this
section:
(1) computed tomography (CT) scanning measuring coronary artery
calcification; or
(2) ultrasonography measuring carotid intima-media thickness and
plaque.
Added by Acts 2009, 81st Leg., R.S., Ch.
1270, Sec. 1, eff. September 1, 2009.