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.