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. 3-12 * * * * *