By Nelson                                               S.B. No. 39

      75R1675 PB-D                           

                                A BILL TO BE ENTITLED

 1-1                                   AN ACT

 1-2     relating to access to certain obstetric or gynecological health

 1-3     care under a health benefits plan.

 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:

 1-5           SECTION 1.  Subchapter E, Chapter 21, Insurance Code, is

 1-6     amended by adding Article 21.53D to read as follows:

 1-7           Art. 21.53D.  ACCESS TO CERTAIN OBSTETRIC OR GYNECOLOGICAL

 1-8     CARE.  (a)  In this article, "health benefits plan" means an

 1-9     individual or group insurance policy, hospital service contract, or

1-10     contract issued by a health maintenance organization that:

1-11                 (1)  is delivered, issued for delivery, or renewed in

1-12     this state;

1-13                 (2)  provides benefits for medical or surgical expenses

1-14     incurred as a result of accident, sickness, or another health

1-15     condition; and

1-16                 (3)  provides benefits for certain specialty health

1-17     care services only through a referral made by a primary care

1-18     physician or other gatekeeper.

1-19           (b)  In addition to other benefits as authorized by the plan,

1-20     each health benefits plan shall permit a woman who is entitled to

1-21     coverage under the plan direct access as provided by Subsection (c)

1-22     of this article to the health care services of a participating

1-23     obstetrician-gynecologist who is:

1-24                 (1)  authorized to provide services under the plan; and

 2-1                 (2)  selected by the covered individual.

 2-2           (c)  The access to health care services required under this

 2-3     article includes an annual gynecological physical examination and

 2-4     additional self-referred office visits as necessary for women's

 2-5     health services.

 2-6           (d)  Each health benefits plan shall provide appropriate

 2-7     written notice to persons covered by the plan of the direct access

 2-8     to health care services required by this article.

 2-9           SECTION 2.  Article 21.53D, Insurance Code, as added by

2-10     Section 1 of this Act, applies only to an insurance policy,

2-11     contract, or evidence of coverage delivered, issued for delivery,

2-12     or renewed on or after January 1, 1998.  A policy, contract, or

2-13     evidence of coverage delivered, issued for delivery, or renewed

2-14     before January 1, 1998, is governed by the law as it existed

2-15     immediately before the effective date of this Act, and that law is

2-16     continued in effect for that purpose.

2-17           SECTION 3.  This Act takes effect September 1, 1997.

2-18           SECTION 4.  The importance of this legislation and the

2-19     crowded condition of the calendars in both houses create an

2-20     emergency and an imperative public necessity that the

2-21     constitutional rule requiring bills to be read on three several

2-22     days in each house be suspended, and this rule is hereby suspended.