85R8019 PMO-D     By: Menéndez S.B. No. 756       A BILL TO BE ENTITLED   AN ACT   relating to required coverage for obesity under group health   benefit plans.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Subtitle E, Title 8, Insurance Code, is amended   by adding Chapter 1372 to read as follows:   CHAPTER 1372. OBESITY          Sec. 1372.001.  APPLICABILITY OF CHAPTER. (a) This chapter   applies only to a group health benefit plan that provides benefits   for medical or surgical expenses incurred as a result of a health   condition, accident, or sickness, including a group insurance   policy, group insurance agreement, group hospital service   contract, or group evidence of coverage or similar coverage   document that is offered 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)  a multiple employer welfare arrangement that holds   a certificate of authority under Chapter 846;                (5)  a stipulated premium company operating under   Chapter 884; or                (6)  a fraternal benefit society operating under   Chapter 885.          (b)  Notwithstanding any other law, this chapter applies to   group coverage provided through a small employer health benefit   plan subject to Chapter 1501, including group coverage provided   through a health group cooperative under Subchapter B of that   chapter.          Sec. 1372.002.  CONDITIONAL EXCEPTION. This chapter does   not apply to a qualified health plan if a determination is made   under 45 C.F.R. Section 155.170 that:                (1)  this chapter requires the plan to offer benefits   in addition to the essential health benefits required under 42   U.S.C. Section 18022(b); and                (2)  this state is required to defray the cost of the   benefits mandated under this chapter.          Sec. 1372.003.  REQUIRED COVERAGE FOR OBESITY. (a) A group   health benefit plan must provide coverage, based on medical   necessity, for the diagnosis and treatment of obesity.          (b)  Coverage required under Subsection (a) is limited to a   service, including bariatric surgery and nutritional counseling   and therapy, or a medication, to the extent the group health benefit   plan provides pharmacy benefits, ordered by a licensed physician,   psychiatrist, psychologist, or therapist within the scope of the   practitioner's license and in accordance with a treatment plan.          (c)  On request from the group health benefit plan issuer, an   obesity treatment plan must include all elements necessary for the   issuer to pay a claim under the group health benefit plan, which may   include a diagnosis, goals, and proposed treatment by type,   frequency, and duration.          SECTION 2.  Not later than November 1 of each even-numbered   year, the comptroller of public accounts shall prepare and submit   to the legislature a biennial report on the human and financial cost   of obesity in this state. This section expires December 1, 2020.          SECTION 3.  The changes in law made by this Act apply only to   a group health benefit plan delivered, issued for delivery, or   renewed on or after January 1, 2018.          SECTION 4.  This Act takes effect September 1, 2017.