Relating to health benefit plan coverage for hair prostheses for breast cancer patients.
HB 233 would require certain health benefit plans in Texas to cover hair prostheses for enrollees who are undergoing or have undergone treatment for breast cancer, when the treating physician determines the prosthesis is appropriate to address treatment-related side effects. The bill also requires coverage for repair or replacement of the hair prosthesis, unless the need arises from misuse or loss by the enrollee. The minimum benefit amount is set at not less than $100, and insurers may not charge an additional premium for this coverage, though normal deductibles, copayments, and coinsurance may still apply.
The bill amends Chapter 1371 of the Insurance Code, which currently addresses coverage for certain prosthetic and orthotic devices and related services, by adding a new subchapter specifically for hair prostheses for breast cancer patients. It expands the law’s reach to a broad range of coverage arrangements, including standard health benefit plans, nonprofit agricultural plans, school district coverage, Medicaid, CHIP, certain regional or local health care programs, and self-funded plans sponsored by professional employer organizations. The bill applies prospectively to plans delivered, issued, or renewed on or after January 1, 2026, and takes effect September 1, 2025.
HB 233 would create a new mandated insurance benefit in Texas law for hair prostheses used by breast cancer patients, requiring coverage across many categories of health benefit plans and public coverage programs. It would add a new Subchapter C to Chapter 1371 of the Insurance Code and extend the statute’s applicability to several plan types that are often exempt from narrower insurance mandates. The bill could affect insurers, managed care plans, Medicaid and CHIP administrators, school district plans, and other covered entities by requiring them to incorporate this benefit into plan design and claims processing for applicable policy years beginning in 2026.
Based on the bill text and the absence of recorded committee testimony or votes in the provided materials, the measure appears to be framed as a patient-support and cancer-care coverage bill with a generally sympathetic policy purpose. The proposal is narrowly targeted to breast cancer patients and sets a modest minimum benefit, suggesting an effort to balance consumer protection with cost containment. No formal opposition or recorded vote history is included in the materials provided, so there is no documented committee or floor sentiment beyond the bill’s supportive framing.
The main points of potential contention are likely to be the breadth of the mandate and its application to public and quasi-public coverage arrangements, including Medicaid, CHIP, school district plans, and self-funded employer-sponsored coverage. Insurers and plan sponsors could object to the bill as an additional mandated benefit, particularly because it prohibits an extra premium while still requiring coverage. Another possible issue is the minimum $100 benefit amount, which may be viewed either as too low to fully cover a hair prosthesis or as a cost-limiting compromise. However, no specific objections or negotiated amendments are reflected in the provided committee record.