Source: http://www.tdi.texas.gov/rules/2001/colon.html
Timestamp: 2017-12-15 10:02:32
Document Index: 452248465

Matched Legal Cases: ['§ 21', '§21', '§21', '§21', '§21', '§21', '§21']

SUBCHAPTER M. Mandatory Notice Requirements 28 TAC §§ 21.2101 21.2103 , 21.2105 and 21.2106
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The Texas Department of Insurance proposes amendments to §§21.2101 21.2103, 21.2105 and 21.2106 concerning mandatory notice of coverage of certain tests for the detection of colorectal cancer. The 77 th Texas Legislature enacted Senate Bill 1467 which added new Article 21.53S to the Texas Insurance Code mandating certain benefits related to the detection of colorectal cancer. Article 21.53S also contains mandatory notice requirements. The department proposes the amendments to the notice provisions in subchapter M to implement the notice requirements in Article 21.53S.
Ms. Stokes has determined that for each year of the first five years the sections are in effect, the public benefit anticipated as a result of the proposed sections will be that affected enrollees are notified on a timely basis of available benefits related to tests for the detection of colorectal cancer. The costs to comply with the proposed amendments are the result of the legislative enactment of SB 1467, which created Article 21.53S. In an effort to minimize costs, carriers may, in a fashion similar to other notices required under this subchapter, deliver the required notice along with other plan documents rather than in a separate mailing. It is the department´s position that the proposed amendments will not have an adverse economic effect on small businesses or micro-businesses and it is neither legal nor feasible to waive these requirements for small or micro businesses because to do so would have an adverse health impact on those entities' enrollees.
To be considered, written comments on the proposal must be submitted no later than 5:00 p.m. on January 28, 2002 to Lynda H. Nesenholtz, General Counsel and Chief Clerk, Mail Code 113-2A, Texas Department of Insurance, P. O. Box 149104, Austin, Texas 78714-9104. An additional copy of the comment must be simultaneously submitted to Diane Moellenberg, Mail Code 107-2A, Texas Department of Insurance, P.O. Box 149104, Austin, Texas 78714-9104. A request for a public hearing should be submitted separately to the Office of the Chief Clerk.
The amendments are proposed under the Insurance Code Article 21.53S and Section 36.001. Article 21.53S provides rulemaking authority to the Commissioner of Insurance for the purpose of administering the statute and directs the Commissioner to adopt rules for the provision of a notice under the statute. Section 36.001 provides that the Commissioner of Insurance may adopt rules and regulations to execute the duties and functions of the Texas Department of Insurance only as authorized by statute.
The following articles are affected by this proposal: Insurance Code Article 21.53S
(1) to require notice to enrollees in a health benefit plan of coverage and/or benefits for prostate cancer examinations; minimum inpatient stays for maternity and childbirth; minimum inpatient stays for mastectomy or lymph node dissection; [ and] reconstructive surgery after mastectomy ; and certain tests for the detection of colorectal cancer. With the exception of notice for reconstructive surgery after mastectomy and notice for colorectal cancer detection, §§21.2102 through 21.2106 of this subchapter apply to all carriers issuing, delivering, or renewing health benefit plans as defined in this subchapter as of January 1, 1998. For state notice requirements pertaining to reconstructive surgery after mastectomy, §§21.2102 - 21.2106 of this subchapter apply to all carriers issuing, delivering, or renewing health benefit plans as defined in this subchapter as of June 18, 1999. For notice requirements pertaining to tests for colorectal cancer detection, §§21.2102-21.2106 of this subchapter apply to all carriers issuing, delivering, or renewing health benefit plans as defined in this subchapter as of January 1, 2002.
(3) Health benefit plan--Subject to subparagraphs (A), (B), (C), [ and] (D) and (E) of this paragraph, a plan that is offered by a carrier and 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, an individual or group evidence of coverage, or any similar coverage document. The term does not include a plan that provides coverage only for accidental death or dismemberment, disability income, supplement to liability insurance, Medicare supplement, workers´ compensation, medical payment insurance issued as a part of a motor vehicle insurance policy or a long-term care policy.
(E) For the detection of colorectal cancer screening coverage notice required by subsection (a)(6) of §21.2103 of this title, the definition of health benefit plan does not include a small employer health benefit plan written under the Insurance Code Chapter 26, Subchapters A-G, or a plan that provides coverage only for a specified disease or other limited benefit or only for indemnity for hospital confinement
(1) (5) (No change.)
(b) (d) (No change.)
(a) (b) (No change.)
Figure Number 6: 28 TAC §21.2106(b)(6)
Benefits are provided, for each person enrolled in the plan who is 50 years of age or older and at normal risk for developing colon cancer, for expenses incurred in conducting a medically recognized screening examination for the detection of colorectal cancer. Benefits include the choice of:
(b) a colonoscopy performed every 10 years. If any person covered by this plan has questions concerning the above, please call [name of carrier] at [customer service or related department phone number], or write us at [carrier´s customer service or related department address]. Form Number 1467 Colorectal Cancer Screening