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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit coverage for certain fertility |
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preservation services under certain health benefit plans. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1366, Insurance Code, is amended by |
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adding Subchapter C to read as follows: |
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SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES |
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Sec. 1366.101. APPLICABILITY OF SUBCHAPTER. (a) This |
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subchapter applies only to a health benefit plan that provides |
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benefits for medical or surgical expenses incurred as a result of a |
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health condition, accident, or sickness, including an individual, |
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group, blanket, or franchise insurance policy or insurance |
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agreement, a group hospital service contract, or an individual or |
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group evidence of coverage or similar coverage document that is |
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issued in this state 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 health maintenance organization operating under |
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Chapter 843; |
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(4) an approved nonprofit health corporation that |
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holds a certificate of authority under Chapter 844; |
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(5) a multiple employer welfare arrangement that holds |
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a certificate of authority under Chapter 846; |
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(6) a stipulated premium company operating under |
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Chapter 884; |
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(7) a fraternal benefit society operating under |
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Chapter 885; |
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(8) a Lloyd's plan operating under Chapter 941; or |
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(9) an exchange operating under Chapter 942. |
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(b) Notwithstanding any other law, this subchapter applies |
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to: |
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(1) a small employer health benefit plan subject to |
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Chapter 1501, including coverage provided through a health group |
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cooperative under Subchapter B of that chapter; and |
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(2) a standard health benefit plan issued under |
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Chapter 1507. |
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Sec. 1366.102. EXCEPTIONS. (a) This subchapter does not |
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apply to: |
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(1) a plan that provides coverage: |
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(A) for wages or payments in lieu of wages for a |
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period during which an employee is absent from work because of |
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sickness or injury; |
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(B) as a supplement to a liability insurance |
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policy; |
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(C) for credit insurance; |
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(D) only for dental or vision care; |
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(E) only for hospital expenses; or |
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(F) only for indemnity for hospital confinement; |
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(2) a Medicare supplemental policy as defined by |
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Section 1882(g)(1), Social Security Act (42 U.S.C. Section |
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1395ss(g)(1)); |
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(3) a workers' compensation insurance policy; |
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(4) medical payment insurance coverage provided under |
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a motor vehicle insurance policy; |
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(5) a long-term care policy, including a nursing home |
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fixed indemnity policy, unless the commissioner determines that the |
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policy provides benefit coverage so comprehensive that the policy |
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is a health benefit plan as described by Section 1366.101; |
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(6) Medicaid managed care programs operated under |
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Chapter 533, Government Code; |
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(7) Medicaid programs operated under Chapter 32, Human |
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Resources Code; or |
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(8) the state child health plan operated under Chapter |
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62 or 63, Health and Safety Code. |
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(b) This subchapter does not apply to a qualified health |
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plan, as defined by 45 C.F.R. Section 155.20, if a determination is |
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made under 45 C.F.R. Section 155.170 that: |
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(1) this subchapter requires the qualified health plan |
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to offer benefits in addition to the essential health benefits |
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required under 42 U.S.C. Section 18022(b); and |
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(2) this state must make payments to defray the cost of |
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the additional benefits mandated by this subchapter. |
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(c) If a determination described by Subsection (b) is made |
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as to a qualified health plan, this subchapter does not apply to a |
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non-qualified health plan if the non-qualified health plan is |
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offered in the same market as the qualified health plan. |
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Sec. 1366.103. REQUIRED COVERAGE. (a) Subject to |
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Subsection (b), a health benefit plan must provide coverage for |
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fertility preservation services to a covered person who will |
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receive a medically necessary treatment, including surgery, |
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chemotherapy, and radiation, that the American Society of Clinical |
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Oncology or the American Society for Reproductive Medicine has |
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established may directly or indirectly cause impaired fertility. |
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(b) The fertility preservation services described by |
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Subsection (a) must be standard procedures to preserve fertility |
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consistent with established medical practices or professional |
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guidelines published by the American Society of Clinical Oncology |
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or the American Society for Reproductive Medicine. |
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SECTION 2. This Act applies only to 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, 2022. |
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SECTION 3. This Act takes effect September 1, 2021. |