The bill, H.B. No. 233, amends the Texas Insurance Code to enhance health benefit plan coverage for hair prostheses specifically for breast cancer patients. It introduces a new subchapter, Subchapter C, which mandates that health benefit plans provide coverage for hair prostheses for enrollees undergoing or who have undergone treatment for breast cancer, as determined appropriate by their treating physician. The bill stipulates that coverage must include the repair or replacement of hair prostheses, with a minimum benefit amount of $100, and prohibits additional premiums for this coverage. Furthermore, it allows for the application of annual deductibles, copayments, and coinsurance consistent with other coverage under the health benefit plan.

In addition to the new provisions for hair prostheses, the bill reorganizes existing sections of Chapter 1371 by designating them into subchapters and updating the language to reflect these changes. It clarifies that covered benefits for prosthetic and orthotic devices are determined by the enrollee's medical needs and outlines the conditions under which these benefits are applicable. The bill will take effect on September 1, 2025, and applies only to health benefit plans delivered, issued for delivery, or renewed on or after January 1, 2026.

Statutes affected:
Introduced: Insurance Code 1371.003, Insurance Code 1371.005 (Insurance Code 1371)