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A BILL TO BE ENTITLED
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AN ACT
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relating to health plan and health benefit plan coverage for |
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abortions. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Title 8, Insurance Code, is amended by adding |
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Subtitle K to read as follows: |
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SUBTITLE K. FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT |
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CHAPTER 1671. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS |
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Sec. 1671.001. DEFINITIONS. In this chapter: |
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(1) "Abortion" has the meaning assigned by Section |
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171.002, Health and Safety Code. |
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(2) "Health benefit exchange" means an American Health |
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Benefit Exchange administered by the federal government or created |
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pursuant to Section 1311(b) of the Patient Protection and |
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Affordable Care Act (Pub. L. No. 111-148). |
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(3) "Qualified health plan" has the meaning assigned |
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by Section 1301(a) of the Patient Protection and Affordable Care |
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Act (Pub. L. No. 111-148). |
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Sec. 1671.002. PROHIBITED COVERAGE THROUGH HEALTH BENEFIT |
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EXCHANGE. (a) A qualified health plan offered through a health |
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benefit exchange may not provide coverage for an abortion other |
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than coverage for an abortion performed when a condition exists, |
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based on the performing physician's good faith clinical judgment, |
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that complicates the medical condition of the pregnant woman and |
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necessitates the abortion of her pregnancy to avert her death. |
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(b) This section does not prevent a person from purchasing |
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optional supplemental coverage for abortions under Section |
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1218.003. |
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SECTION 2. Subtitle A, Title 8, Insurance Code, is amended |
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by adding Chapter 1218 to read as follows: |
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CHAPTER 1218. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS |
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Sec. 1218.001. DEFINITION. In this chapter, "abortion" has |
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the meaning assigned by Section 171.002, Health and Safety Code. |
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Sec. 1218.002. APPLICABILITY OF CHAPTER. (a) This chapter |
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applies only to a health benefit plan that provides benefits for |
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medical or surgical expenses incurred as a result of a health |
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condition, accident, or sickness, including an individual, group, |
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blanket, or franchise insurance policy or insurance agreement, a |
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group hospital service contract, or an individual or group evidence |
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of coverage or similar coverage document that is offered by: |
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(1) an insurance company; |
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(2) a group hospital service corporation operating |
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under Chapter 842; |
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(3) a fraternal benefit society operating under |
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Chapter 885; |
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(4) a stipulated premium company operating under |
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Chapter 884; |
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(5) an exchange operating under Chapter 942; |
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(6) a health maintenance organization operating under |
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Chapter 843; |
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(7) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; or |
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(8) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844. |
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(b) This chapter applies to group health coverage made |
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available by a school district in accordance with Section 22.004, |
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Education Code. |
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(c) Notwithstanding Section 172.014, Local Government Code, |
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or any other law, this chapter applies to health and accident |
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coverage provided by a risk pool created under Chapter 172, Local |
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Government Code. |
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(d) Notwithstanding any provision in Chapter 1551, 1575, |
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1579, or 1601 or any other law, this chapter applies to: |
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(1) a basic coverage plan under Chapter 1551; |
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(2) a basic plan under Chapter 1575; |
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(3) a primary care coverage plan under Chapter 1579; |
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and |
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(4) basic coverage under Chapter 1601. |
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(e) Notwithstanding Section 1501.251 or any other law, this |
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chapter applies to coverage under a small or large employer health |
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benefit plan subject to Chapter 1501. |
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(f) Notwithstanding Section 1507.003 or 1507.053, this |
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chapter applies to a standard health benefit plan provided under |
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Chapter 1507. |
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Sec. 1218.003. COVERAGE BY HEALTH BENEFIT PLAN. (a) Except |
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as provided by Subsection (b), a health benefit plan may provide |
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coverage for abortion only if: |
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(1) the coverage is provided to an enrollee separately |
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from other health benefit plan coverage offered by the health |
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benefit plan issuer; |
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(2) an enrollee pays separately from, and in addition |
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to, the premium for other health benefit plan coverage a premium for |
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coverage for abortion; and |
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(3) an enrollee provides a signature for coverage for |
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abortion, separately and distinct from the signature required for |
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other health benefit plan coverage offered by the health benefit |
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plan issuer. |
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(b) Notwithstanding Subsection (a), a health benefit plan |
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may provide coverage for an abortion performed when a condition |
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exists, based on the performing physician's good faith clinical |
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judgment, that complicates the condition of a pregnant enrollee and |
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necessitates the abortion to avert the enrollee's death. |
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Sec. 1218.004. CALCULATION OF PREMIUM. (a) A health |
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benefit plan issuer that provides coverage for abortion shall |
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calculate the premium for the coverage so that the premium fully |
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covers the estimated cost of abortion per enrollee, determined on |
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an average actuarial basis. |
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(b) In calculating a premium under Subsection (a), the |
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health benefit plan issuer may not take into account any cost |
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savings in other health benefit plan coverage offered by the health |
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benefit plan issuer that is estimated to result from coverage for |
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abortion, including costs associated with prenatal care, delivery, |
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or postnatal care. |
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(c) A health benefit plan issuer that provides coverage |
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other than coverage for abortion may not provide a premium discount |
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to or reduce the premium for an enrollee for coverage other than |
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coverage for abortion on the basis that the enrollee has health |
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benefit plan coverage for abortion. |
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Sec. 1218.005. NOTICE BY ISSUER. A health benefit plan |
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issuer that provides coverage for abortion shall at the time of |
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enrollment in the health benefit plan provide each enrollee with a |
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notice that: |
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(1) coverage for abortion is optional and separate |
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from other health benefit plan coverage offered by the health |
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benefit plan issuer; |
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(2) the premium cost for coverage for abortion is a |
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premium paid separately from, and in addition to, the premium for |
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other health benefit plan coverage offered by the health benefit |
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plan issuer; and |
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(3) the enrollee may enroll in a health benefit plan |
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that provides coverage other than coverage for abortion without |
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obtaining coverage for abortion. |
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Sec. 1218.006. ACCEPTANCE OR REJECTION OF COVERAGE BY |
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EMPLOYEES AND GROUP MEMBERS. If a small or large employer health |
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benefit plan or group health benefit plan offers coverage for |
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abortion, the employer offering the employee health benefit plan or |
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the entity offering the group health benefit plan shall provide |
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each employee or group member with an opportunity to accept or |
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reject coverage for abortion: |
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(1) at the beginning of employment or when the group |
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member's coverage begins, as applicable; and |
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(2) at least one time in each calendar year after the |
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first year of employment or group coverage. |
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SECTION 3. This Act applies only to a qualified health plan |
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offered through a health benefit exchange or a health benefit plan |
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that is delivered, issued for delivery, or renewed on or after |
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January 1, 2012. A qualified health plan offered through a health |
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benefit exchange or a health benefit plan that is delivered, issued |
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for delivery, or renewed before January 1, 2012, is governed by the |
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law as it existed immediately before the effective date of this Act, |
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and that law is continued in effect for that purpose. |
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SECTION 4. This Act takes effect September 1, 2011. |