1-1     By:  Thompson, et al. (Senate Sponsor - Wentworth)    H.B. No. 2382
 1-2           (In the Senate - Received from the House May 4, 2001;
 1-3     May 7, 2001, read first time and referred to Committee on Business
 1-4     and Commerce; May 11, 2001, reported favorably by the following
 1-5     vote:  Yeas 6, Nays 0; May 11, 2001, sent to printer.)
 1-6                            A BILL TO BE ENTITLED
 1-7                                   AN ACT
 1-8     relating to coverage under a health benefit plan for prescription
 1-9     contraceptive drugs and devices and related services.
1-10           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
1-11           SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
1-12     amended by adding Article 21.52L to read as follows:
1-13           Art. 21.52L.  HEALTH BENEFIT PLAN COVERAGE FOR PRESCRIPTION
1-14     CONTRACEPTIVE DRUGS AND DEVICES AND RELATED SERVICES
1-15           Sec. 1.  GENERAL DEFINITIONS. In this article:
1-16                 (1)  "Enrollee" means any person who is entitled to
1-17     benefits under a health benefit plan.
1-18                 (2)  "Outpatient contraceptive service" means a
1-19     consultation, examination, procedure, or medical service that is
1-20     provided on an outpatient basis and that is related to the use of a
1-21     drug or device intended to prevent pregnancy.
1-22           Sec. 2.  DEFINITION OF HEALTH BENEFIT PLAN. (a)  In this
1-23     article, "health benefit plan" means a plan that provides benefits
1-24     for medical or surgical expenses incurred as a result of a health
1-25     condition, accident, or sickness, including an individual, group,
1-26     blanket, or franchise insurance policy or insurance agreement, a
1-27     group hospital service contract, or an individual or group evidence
1-28     of coverage or similar coverage document that is offered by:
1-29                 (1)  an insurance company;
1-30                 (2)  a group hospital service corporation operating
1-31     under Chapter 20 of this code;
1-32                 (3)  a fraternal benefit society operating under
1-33     Chapter 10 of this code;
1-34                 (4)  a stipulated premium insurance company operating
1-35     under Chapter 22 of this code;
1-36                 (5)  a reciprocal exchange operating under Chapter 19
1-37     of this code;
1-38                 (6)  a health maintenance organization operating under
1-39     the Texas Health Maintenance Organization Act (Chapter 20A,
1-40     Vernon's Texas Insurance Code);
1-41                 (7)  a multiple employer welfare arrangement that holds
1-42     a certificate of authority under Article 3.95-2 of this code; or
1-43                 (8)  an approved nonprofit health corporation that
1-44     holds a certificate of authority under Article 21.52F of this code.
1-45           (b)  "Health benefit plan" includes a small employer health
1-46     benefit plan offered in accordance with Chapter 26 of this code.
1-47           (c)  "Health benefit plan" does not include:
1-48                 (1)  a plan that provides coverage only:
1-49                       (A)  for benefits for a specified disease or for
1-50     another limited benefit other than for cancer;
1-51                       (B)  for accidental death or dismemberment;
1-52                       (C)  for wages or payments in lieu of wages for a
1-53     period during which an employee is absent from work because of
1-54     sickness or injury;
1-55                       (D)  as a supplement to a liability insurance
1-56     policy;
1-57                       (E)  for credit insurance;
1-58                       (F)  for dental or vision care; or
1-59                       (G)  for indemnity for hospital confinement;
1-60                 (2)  a Medicare supplemental policy as defined by
1-61     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
1-62     as amended;
1-63                 (3)  a workers' compensation insurance policy;
1-64                 (4)  medical payment insurance coverage provided under
 2-1     a motor vehicle insurance policy; or
 2-2                 (5)  a long-term care insurance policy, including a
 2-3     nursing home fixed indemnity policy, unless the commissioner
 2-4     determines that the policy provides benefit coverage so
 2-5     comprehensive that the policy is a health benefit plan as described
 2-6     by Subsection (a) of this section.
 2-7           Sec. 3.  PROHIBITED EXCLUSION OR LIMITATION. (a)  A health
 2-8     benefit plan that provides benefits for prescription drugs or
 2-9     devices may not exclude or limit benefits to enrollees for:
2-10                 (1)  a prescription contraceptive drug or device
2-11     approved by the United States Food and Drug Administration; or
2-12                 (2)  an outpatient contraceptive service.
2-13           (b)  This section does not prohibit a limitation that applies
2-14     to all prescription drugs or devices or all services for which
2-15     benefits are provided under a health benefit plan.
2-16           (c)  This section does not provide coverage for
2-17     abortifacients or any other drug or device that terminates a
2-18     pregnancy.
2-19           Sec. 4.  PROHIBITED COST-SHARING PROVISIONS. (a)  A health
2-20     benefit plan may not impose any deductible, copayment, coinsurance,
2-21     or other cost-sharing provision applicable to benefits for
2-22     prescription contraceptive drugs or devices unless the amount of
2-23     the required cost-sharing does not exceed the amount of the
2-24     required cost-sharing applicable to benefits for other prescription
2-25     drugs or devices under the plan.
2-26           (b)  A health benefit plan may not impose any deductible,
2-27     copayment, coinsurance, or other cost-sharing provision applicable
2-28     to benefits for outpatient contraceptive services unless the amount
2-29     of the required cost-sharing does not exceed the amount of the
2-30     required cost-sharing applicable to benefits for other outpatient
2-31     services under the plan.
2-32           Sec. 5.  PROHIBITED WAITING PERIOD. (a)  A health benefit
2-33     plan may not impose any waiting period applicable to benefits for
2-34     prescription contraceptive drugs or devices unless the waiting
2-35     period is not longer than any waiting period applicable to benefits
2-36     for other prescription drugs or devices under the plan.
2-37           (b)  A health benefit plan may not impose any waiting period
2-38     applicable to benefits for outpatient contraceptive services unless
2-39     the waiting period is not longer than any waiting period applicable
2-40     to benefits for other outpatient services under the plan.
2-41           Sec. 6.  PROHIBITED CONDUCT. The issuer of a health benefit
2-42     plan may not:
2-43                 (1)  deny an applicant for enrollment or an enrollee
2-44     eligibility or continued eligibility under the plan, or deny
2-45     renewal of a plan to an enrollee, solely because of the applicant's
2-46     or enrollee's use or potential use of a prescription contraceptive
2-47     drug or device or an outpatient contraceptive service;
2-48                 (2)  provide a monetary incentive to an applicant for
2-49     enrollment or an enrollee to induce the applicant or enrollee to
2-50     accept coverage that does not satisfy the requirements of this
2-51     article; or
2-52                 (3)  reduce or limit a payment to a health care
2-53     professional, or otherwise penalize the professional, because the
2-54     professional prescribes a contraceptive drug or device  or provides
2-55     an outpatient contraceptive service.
2-56           Sec. 7.  EXEMPTION. (a)  This article does not require a
2-57     health benefit plan that is issued by an entity associated with a
2-58     religious organization or any physician or health care provider
2-59     providing medical or health care services under the health benefit
2-60     plan to offer,  recommend, offer advice concerning, pay for,
2-61     provide, assist in, perform, arrange, or participate in providing
2-62     or performing a medical or health care service that violates the
2-63     religious convictions of the organization, except if the
2-64     prescription contraceptive coverage is necessary to preserve the
2-65     life or health of the insured individual.
2-66           (b)  The issuer of a health benefit plan that limits or
2-67     excludes coverage for medical or health care services under this
2-68     section must state the limitation or exclusion in the coverage
2-69     document, the plan's statement of benefits, brochures, and other
 3-1     informational materials for the health benefit plan.
 3-2           Sec. 8.  ENFORCEMENT. The issuer of a health benefit plan
 3-3     that violates this article is subject to the enforcement provisions
 3-4     of Subtitle B, Title 2, of this code.
 3-5           SECTION 2. This Act takes effect September 1, 2001, and
 3-6     applies only to a health benefit plan that is delivered, issued for
 3-7     delivery, or renewed on or after January 1, 2002.  A plan that is
 3-8     delivered, issued for delivery, or renewed before January 1, 2002,
 3-9     is governed by the law as it existed immediately before the
3-10     effective date of this Act, and that law is continued in effect for
3-11     that purpose.
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