By Thompson, Gray, Villarreal, Wohlgemuth, H.B. No. 2382
A BILL TO BE ENTITLED
1-1 AN ACT
1-2 relating to coverage under a health benefit plan for prescription
1-3 contraceptive drugs and devices and related services.
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 21.52L to read as follows:
1-7 Art. 21.52L. HEALTH BENEFIT PLAN COVERAGE FOR PRESCRIPTION
1-8 CONTRACEPTIVE DRUGS AND DEVICES AND RELATED SERVICES
1-9 Sec. 1. GENERAL DEFINITIONS. In this article:
1-10 (1) "Enrollee" means any person who is entitled to
1-11 benefits under a health benefit plan.
1-12 (2) "Outpatient contraceptive service" means a
1-13 consultation, examination, procedure, or medical service that is
1-14 provided on an outpatient basis and that is related to the use of a
1-15 drug or device intended to prevent pregnancy.
1-16 Sec. 2. DEFINITION OF HEALTH BENEFIT PLAN. (a) In this
1-17 article, "health benefit plan" means a plan that provides benefits
1-18 for medical or surgical expenses incurred as a result of a health
1-19 condition, accident, or sickness, including an individual, group,
1-20 blanket, or franchise insurance policy or insurance agreement, a
1-21 group hospital service contract, or an individual or group evidence
1-22 of coverage or similar coverage document that is offered by:
1-23 (1) an insurance company;
1-24 (2) a group hospital service corporation operating
1-25 under Chapter 20 of this code;
2-1 (3) a fraternal benefit society operating under
2-2 Chapter 10 of this code;
2-3 (4) a stipulated premium insurance company operating
2-4 under Chapter 22 of this code;
2-5 (5) a reciprocal exchange operating under Chapter 19
2-6 of this code;
2-7 (6) a health maintenance organization operating under
2-8 the Texas Health Maintenance Organization Act (Chapter 20A,
2-9 Vernon's Texas Insurance Code);
2-10 (7) a multiple employer welfare arrangement that holds
2-11 a certificate of authority under Article 3.95-2 of this code; or
2-12 (8) an approved nonprofit health corporation that
2-13 holds a certificate of authority under Article 21.52F of this code.
2-14 (b) "Health benefit plan" includes a small employer health
2-15 benefit plan offered in accordance with Chapter 26 of this code.
2-16 (c) "Health benefit plan" does not include:
2-17 (1) a plan that provides coverage only:
2-18 (A) for benefits for a specified disease or for
2-19 another limited benefit other than for cancer;
2-20 (B) for accidental death or dismemberment;
2-21 (C) for wages or payments in lieu of wages for a
2-22 period during which an employee is absent from work because of
2-23 sickness or injury;
2-24 (D) as a supplement to a liability insurance
2-25 policy;
2-26 (E) for credit insurance;
2-27 (F) for dental or vision care; or
3-1 (G) for indemnity for hospital confinement;
3-2 (2) a Medicare supplemental policy as defined by
3-3 Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
3-4 as amended;
3-5 (3) a workers' compensation insurance policy;
3-6 (4) medical payment insurance coverage provided under
3-7 a motor vehicle insurance policy; or
3-8 (5) a long-term care insurance policy, including a
3-9 nursing home fixed indemnity policy, unless the commissioner
3-10 determines that the policy provides benefit coverage so
3-11 comprehensive that the policy is a health benefit plan as described
3-12 by Subsection (a) of this section.
3-13 Sec. 3. PROHIBITED EXCLUSION OR LIMITATION. (a) A health
3-14 benefit plan that provides benefits for prescription drugs or
3-15 devices may not exclude or limit benefits to enrollees for:
3-16 (1) a prescription contraceptive drug or device
3-17 approved by the United States Food and Drug Administration; or
3-18 (2) an outpatient contraceptive service.
3-19 (b) This section does not prohibit a limitation that applies
3-20 to all prescription drugs or devices or all services for which
3-21 benefits are provided under a health benefit plan.
3-22 (c) This section does not provide coverage for
3-23 abortifacients or any other drug or device that terminates a
3-24 pregnancy.
3-25 Sec. 4. PROHIBITED COST-SHARING PROVISIONS. (a) A health
3-26 benefit plan may not impose any deductible, copayment, coinsurance,
3-27 or other cost-sharing provision applicable to benefits for
4-1 prescription contraceptive drugs or devices unless the amount of
4-2 the required cost-sharing does not exceed the amount of the
4-3 required cost-sharing applicable to benefits for other prescription
4-4 drugs or devices under the plan.
4-5 (b) A health benefit plan may not impose any deductible,
4-6 copayment, coinsurance, or other cost-sharing provision applicable
4-7 to benefits for outpatient contraceptive services unless the amount
4-8 of the required cost-sharing does not exceed the amount of the
4-9 required cost-sharing applicable to benefits for other outpatient
4-10 services under the plan.
4-11 Sec. 5. PROHIBITED WAITING PERIOD. (a) A health benefit
4-12 plan may not impose any waiting period applicable to benefits for
4-13 prescription contraceptive drugs or devices unless the waiting
4-14 period is not longer than any waiting period applicable to benefits
4-15 for other prescription drugs or devices under the plan.
4-16 (b) A health benefit plan may not impose any waiting period
4-17 applicable to benefits for outpatient contraceptive services unless
4-18 the waiting period is not longer than any waiting period applicable
4-19 to benefits for other outpatient services under the plan.
4-20 Sec. 6. PROHIBITED CONDUCT. The issuer of a health benefit
4-21 plan may not:
4-22 (1) deny an applicant for enrollment or an enrollee
4-23 eligibility or continued eligibility under the plan, or deny
4-24 renewal of a plan to an enrollee, solely because of the applicant's
4-25 or enrollee's use or potential use of a prescription contraceptive
4-26 drug or device or an outpatient contraceptive service;
4-27 (2) provide a monetary incentive to an applicant for
5-1 enrollment or an enrollee to induce the applicant or enrollee to
5-2 accept coverage that does not satisfy the requirements of this
5-3 article; or
5-4 (3) reduce or limit a payment to a health care
5-5 professional, or otherwise penalize the professional, because the
5-6 professional prescribes a contraceptive drug or device or provides
5-7 an outpatient contraceptive service.
5-8 Sec. 7. EXEMPTION. (a) This article does not require a
5-9 health benefit plan that is issued by an entity associated with a
5-10 religious organization or any physician or health care provider
5-11 providing medical or health care services under the health benefit
5-12 plan to offer, recommend, offer advice concerning, pay for,
5-13 provide, assist in, perform, arrange, or participate in providing
5-14 or performing a medical or health care service that violates the
5-15 religious convictions of the organization, except if the
5-16 prescription contraceptive coverage is necessary to preserve the
5-17 life or health of the insured individual.
5-18 (b) The issuer of a health benefit plan that limits or
5-19 excludes coverage for medical or health care services under this
5-20 section must state the limitation or exclusion in the coverage
5-21 document, the plan's statement of benefits, brochures, and other
5-22 informational materials for the health benefit plan.
5-23 Sec. 8. ENFORCEMENT. The issuer of a health benefit plan
5-24 that violates this article is subject to the enforcement provisions
5-25 of Subtitle B, Title 2, of this code.
5-26 SECTION 2. This Act takes effect September 1, 2001, and
5-27 applies only to a health benefit plan that is delivered, issued for
6-1 delivery, or renewed on or after January 1, 2002. A plan that is
6-2 delivered, issued for delivery, or renewed before January 1, 2002,
6-3 is governed by the law as it existed immediately before the
6-4 effective date of this Act, and that law is continued in effect for
6-5 that purpose.