BILL ANALYSIS |
C.S.S.B 575 |
By: Taylor, Larry |
State Affairs |
Committee Report (Substituted) |
BACKGROUND AND PURPOSE
Interested observers contend that certain qualified health plans should be prohibited from providing coverage for abortions except under certain circumstances. C.S.S.B 575 seeks to address this issue.
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CRIMINAL JUSTICE IMPACT
It is the committee's opinion that this bill does not expressly create a criminal offense, increase the punishment for an existing criminal offense or category of offenses, or change the eligibility of a person for community supervision, parole, or mandatory supervision.
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RULEMAKING AUTHORITY
It is the committee's opinion that this bill does not expressly grant any additional rulemaking authority to a state officer, department, agency, or institution.
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ANALYSIS
C.S.S.B. 575 amends the Insurance Code to prohibit a qualified health plan offered through a health benefit exchange administered by the federal government or created under the federal Patient Protection and Affordable Care Act from providing coverage for an abortion other than coverage for an abortion performed due to a medical emergency, as defined by the Woman's Right to Know Act. The bill establishes that the exception to the coverage prohibition for an abortion performed due to a medical emergency does not authorize coverage for an abortion based on a potential future medical condition that may result from a voluntary act of the woman or minor. The bill establishes that the prohibition against providing coverage for abortion through a qualified health plan does not prevent a person from purchasing optional or supplemental coverage for abortions under a health benefit plan other than a qualified health plan offered through a health benefit exchange. The bill establishes that its provisions regarding qualified health plan abortion coverage do not constitute an acknowledgment by the Texas Legislature of the legitimacy of the federal Patient Protection and Affordable Care Act as a constitutional exercise of the power of the United States Congress.
C.S.S.B. 575 conditions the authorization for a health benefit plan to provide coverage for abortion on the coverage being provided to an enrollee separately from other health benefit plan coverage offered by the health benefit plan issuer; an enrollee paying a premium for coverage for abortion separately from, and in addition to, the premium for other health benefit plan coverage; an enrollee providing a signature for coverage for abortion, separately and distinct from the signature required for other health benefit plan coverage offered by the health benefit plan issuer; or the coverage providing benefits only for an abortion due to a medical emergency. The bill establishes that a health benefit plan's authority to provide coverage for an abortion due to a medical emergency does not authorize coverage for an abortion based on a potential future medical condition that may result from a voluntary act of the enrollee.
C.S.S.B 575 requires a health benefit plan issuer that provides coverage for abortion to calculate the premium for the coverage so that the premium fully covers the estimated cost of abortion per enrollee, determined on an average actuarial basis. The bill prohibits a health benefit plan issuer, in calculating a premium for abortion coverage, from taking into account any cost savings in other health benefit plan coverage offered by the health benefit plan issuer that is estimated to result from coverage for abortion. The bill prohibits a health benefit plan issuer that provides coverage other than coverage for abortion from providing a premium discount to, or reducing the premium for, an enrollee for coverage other than coverage for abortion on the basis that the enrollee has health benefit plan coverage for abortion.
C.S.S.B 575 requires a health benefit plan issuer that provides coverage for abortion to provide each enrollee at the time of enrollment in the health benefit plan with a notice that coverage for abortion is optional and separate from other health benefit plan coverage offered by the health benefit plan issuer, that the premium cost for coverage for abortion is a premium paid separately from, and in addition to, the premium for other health benefit plan coverage offered by the health benefit plan issuer, and that the enrollee may enroll in a health benefit plan that provides coverage other than coverage for abortion without obtaining coverage for abortion.
C.S.S.B 575 requires an employer or entity offering a health benefit plan that offers coverage for abortion to provide each employee or group member with an opportunity to accept or reject supplemental coverage for abortion at the beginning of employment or when the group member's coverage begins, as applicable, and at least one time in each calendar year after the first year of employment or group coverage.
C.S.S.B 575 applies its provisions governing coverage for abortion through a health benefit plan to specified health benefit plans. The bill applies only to a qualified health plan offered through a health benefit exchange or a health benefit plan that is delivered, issued for delivery, or renewed on or after January 1, 2016.
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EFFECTIVE DATE
September 1, 2015.
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COMPARISON OF SENATE ENGROSSED AND SUBSTITUTE
While C.S.S.B 575 may differ from the engrossed in minor or nonsubstantive ways, the following comparison is organized and formatted in a manner that indicates the substantial differences between the engrossed and committee substitute versions of the bill.
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