| |
| |
|
|
A BILL TO BE ENTITLED
|
|
|
AN ACT
|
|
|
relating to health benefit plan coverage of prescription |
|
|
contraceptive drugs. |
|
|
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
|
|
SECTION 1. Section 1369.102, Insurance Code, is amended to |
|
|
read as follows: |
|
|
Sec. 1369.102. APPLICABILITY OF SUBCHAPTER. Except as |
|
|
otherwise provided by this subchapter, this [This] subchapter |
|
|
applies only to a health benefit plan, including a small employer |
|
|
health benefit plan written under Chapter 1501, 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 |
|
|
offered by: |
|
|
(1) an insurance company; |
|
|
(2) a group hospital service corporation operating |
|
|
under Chapter 842; |
|
|
(3) a fraternal benefit society operating under |
|
|
Chapter 885; |
|
|
(4) a stipulated premium company operating under |
|
|
Chapter 884; |
|
|
(5) a reciprocal exchange operating under Chapter 942; |
|
|
(6) a health maintenance organization operating under |
|
|
Chapter 843; |
|
|
(7) a multiple employer welfare arrangement that holds |
|
|
a certificate of authority under Chapter 846; or |
|
|
(8) an approved nonprofit health corporation that |
|
|
holds a certificate of authority under Chapter 844. |
|
|
SECTION 2. Subchapter C, Chapter 1369, Insurance Code, is |
|
|
amended by adding Section 1369.1031 to read as follows: |
|
|
Sec. 1369.1031. CERTAIN COVERAGE REQUIRED. (a) This |
|
|
section applies to a health benefit plan described by Section |
|
|
1369.102. |
|
|
(b) Notwithstanding any other law, this section applies to: |
|
|
(1) a standard health benefit plan issued under |
|
|
Chapter 1507; |
|
|
(2) a basic coverage plan under Chapter 1551; |
|
|
(3) a basic plan under Chapter 1575; |
|
|
(4) a primary care coverage plan under Chapter 1579; |
|
|
(5) a plan providing basic coverage under Chapter |
|
|
1601; |
|
|
(6) group health coverage made available by a school |
|
|
district in accordance with Section 22.004, Education Code; |
|
|
(7) the state Medicaid program, including the Medicaid |
|
|
managed care program operated under Chapter 533, Government Code; |
|
|
and |
|
|
(8) the child health plan program under Chapter 62, |
|
|
Health and Safety Code. |
|
|
(c) A health benefit plan that provides benefits for a |
|
|
prescription contraceptive drug must provide for an enrollee to |
|
|
obtain up to: |
|
|
(1) a three-month supply of the covered prescription |
|
|
contraceptive drug at one time the first time the enrollee obtains |
|
|
the drug; and |
|
|
(2) a 12-month supply of the covered prescription |
|
|
contraceptive drug at one time each subsequent time the enrollee |
|
|
obtains the same drug, regardless of whether the enrollee was |
|
|
enrolled in the health benefit plan the first time the enrollee |
|
|
obtained the drug. |
|
|
(d) An enrollee may obtain only one 12-month supply of a |
|
|
covered prescription contraceptive drug during each 12-month |
|
|
period. |
|
|
SECTION 3. The change in law made by this Act applies only |
|
|
to a health benefit plan that is delivered, issued for delivery, or |
|
|
renewed on or after January 1, 2024. A health benefit plan that is |
|
|
delivered, issued for delivery, or renewed before January 1, 2024, |
|
|
is governed by the law as it existed immediately before the |
|
|
effective date of this Act, and that law is continued in effect for |
|
|
that purpose. |
|
|
SECTION 4. This Act takes effect September 1, 2023. |