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A BILL TO BE ENTITLED
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AN ACT
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relating to required health benefit plan coverage for gender |
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transition adverse effects and reversals. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Subtitle E, Title 8, Insurance Code, is amended |
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by adding Chapter 1372 to read as follows: |
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CHAPTER 1372. REQUIRED COVERAGE OF GENDER TRANSITION ADVERSE |
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EFFECTS AND REVERSALS |
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Sec. 1372.001. DEFINITIONS. In this chapter: |
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(1) "Gender transition" means the process by which an |
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individual progresses from identifying with and living as the |
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gender that corresponds to the individual's biological sex to |
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identifying with and living as a gender different than the |
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individual's biological sex. |
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(2) "Gender transition procedure or treatment" means a |
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medical procedure or treatment performed or provided for the |
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purpose of assisting an individual with a gender transition. |
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Sec. 1372.002. APPLICABILITY OF CHAPTER. (a) This |
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chapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses or pharmacy benefits |
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incurred as a result of a health condition, accident, or sickness, |
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including an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage or similar coverage |
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document that is issued by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this chapter applies to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; |
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(2) a standard health benefit plan issued under |
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Chapter 1507; |
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(3) a basic coverage plan under Chapter 1551; |
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(4) a basic plan under Chapter 1575; |
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(5) a primary care coverage plan under Chapter 1579; |
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(6) a plan providing basic coverage under Chapter |
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1601; |
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(7) nonprofit agricultural organization health |
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benefits offered by a nonprofit agricultural organization under |
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Chapter 1682; |
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(8) alternative health benefit coverage offered by a |
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subsidiary of the Texas Mutual Insurance Company under Subchapter |
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M, Chapter 2054; |
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(9) health benefits provided by or through a church |
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benefits board under Subchapter I, Chapter 22, Business |
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Organizations Code; |
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(10) group health coverage made available by a school |
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district in accordance with Section 22.004, Education Code; |
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(11) the state Medicaid program, including the |
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Medicaid managed care program operated under Chapter 533, |
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Government Code; |
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(12) the child health plan program under Chapter 62, |
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Health and Safety Code; |
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(13) a regional or local health care program operated |
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under Section 75.104, Health and Safety Code; |
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(14) a self-funded health benefit plan sponsored by a |
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professional employer organization under Chapter 91, Labor Code; |
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(15) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(16) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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(c) This chapter applies to coverage under a group health |
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benefit plan provided to a resident of this state regardless of |
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whether the group policy, agreement, or contract is delivered, |
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issued for delivery, or renewed in this state. |
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(d) This chapter does not apply to a self-funded health |
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benefit plan as defined by the Employee Retirement Income Security |
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Act of 1974 (29 U.S.C. Section 1001 et seq.). |
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Sec. 1372.003. REQUIRED COVERAGE. (a) A health benefit |
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plan that provides coverage for an enrollee's gender transition |
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procedure or treatment shall provide coverage for: |
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(1) all possible adverse consequences related to the |
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enrollee's gender transition procedure or treatment, including any |
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short- or long-term side effects of the procedure or treatment; |
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(2) any testing or screening necessary to monitor the |
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mental and physical health of the enrollee on at least an annual |
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basis; and |
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(3) any procedure or treatment necessary to reverse |
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the enrollee's gender transition procedure or treatment. |
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(b) A health benefit plan that offers coverage for a gender |
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transition procedure or treatment shall also provide the coverage |
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described by Subsection (a) to any enrollee who has undergone a |
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gender transition procedure or treatment regardless of whether the |
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enrollee was enrolled in the plan at the time of the procedure or |
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treatment. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. Section 1372.003, Insurance Code, as added by |
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this Act, applies only to a health benefit plan that is delivered, |
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issued for delivery, or renewed on or after January 1, 2024. |
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SECTION 4. This Act takes effect September 1, 2023. |