HB 616

relating to health benefit plan coverage for certain at-home
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1.  Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1381 to read as follows:
CHAPTER 1381. COVERAGE FOR AT-HOME TESTING KITS
Sec. 1381.001.  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 evidence
of coverage or similar coverage document that is issued by:
(2)  a group hospital service corporation operating
(3)  a health maintenance organization operating under
(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
(7)  a fraternal benefit society operating under
(8)  a Lloyd's plan operating under Chapter 941; or
(9)  an 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
(3)  a basic coverage plan under Chapter 1551;
(4)  a basic plan under Chapter 1575;
(5)  a primary care coverage plan under Chapter 1579;
(6)  a plan providing basic coverage under Chapter
(7)  the state Medicaid program, including the Medicaid
managed care program operated under Chapter 540, Government Code;
(8)  the child health plan program under Chapter 62,
(9)  a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code.
Sec. 1381.002.  COVERAGE REQUIRED FOR CERTAIN AT-HOME
TESTING KITS.  (a)  A health benefit plan must provide coverage in
accordance with this section for an at-home testing kit that tests
(1)  coronavirus, influenza, or both coronavirus and
influenza and is approved by the United States Food and Drug
Administration for that use; or
(2)  a disease for which the kit has been approved by
the United States Food and Drug Administration for emergency use.
(b)  A health benefit plan must provide coverage for at least
four kits described by Subsection (a) per enrollee per month.
SECTION 2.  If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3.  Chapter 1381, 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 4.  This Act takes effect September 1, 2025.