By: Cole H.B. No. 3586
 
 
 
A BILL TO BE ENTITLED
 
AN ACT
  relating to the coverage and provision of abortion and
  contraception under a health benefit plan and certain programs
  administered by this state.
         BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
         SECTION 1.  Section 32.024, Human Resources Code, is amended
  by amending Subsection (e) and adding Subsection (mm) to read as
  follows:
         (e)  The commission may not authorize the provision of any
  service to any person under the program unless federal matching
  funds are available to pay the cost of the service, except that the
  commission shall provide abortion services and all FDA approved
  forms of contraception, including device insertion and removal and
  voluntary sterilization including vasectomies regardless of
  whether federal matching funds are available to pay for the cost of
  those services.
         (mm)  The commission shall provide abortion services and
  contraception under the medical assistance program in accordance
  with applicable state and federal law.
               (1)  Notwithstanding any other provision in this code,
  abortion contraception and sterilization services shall not be
  subject to:
                     (a)  any cost sharing for those services,
  including deductible or coinsurance. [B1]
                     (b)  utilization review
                     (c)  prior authorization or step-therapy
  requirements; or
                     (d)  any restrictions or delays on the coverage.
         SECTION 2.  Chapter 1218 Insurance Code, is amended to read
  as follows:
  CHAPTER 1218. COVERAGE FOR ELECTIVE ABORTION AND CONTRACEPTION;
  PROHIBITIONS AND REQUIREMENTS
         Sec. 1218.001.  DEFINITION. In this chapter, "elective
  abortion" means an abortion, as defined by Section 245.002, Health
  and Safety Code, other than an abortion performed due to a medical
  emergency as defined by Section 171.002, Health and Safety Code.
         Sec. 1218.002.  APPLICABILITY OF CHAPTER. (a) This chapter
  applies only to a health benefit plan that provides benefits for
  medical or surgical expenses incurred as a result of a health
  condition, accident, or sickness, including an individual, group,
  blanket, or franchise insurance policy or insurance agreement, a
  group hospital service contract, or an individual or group evidence
  of coverage or similar coverage document that is offered by:
               (1)  an insurance company;
               (2)  a group hospital service corporation operating
  under Chapter 842;
               (3)  a fraternal benefit society operating under
  Chapter 885;
               (4)  a stipulated premium company operating under
  Chapter 884;
               (5)  an exchange operating under Chapter 942;
               (6)  a health maintenance organization operating under
  Chapter 843;
               (7)  a multiple employer welfare arrangement that holds
  a certificate of authority under Chapter 846; or
               (8)  an approved nonprofit health corporation that
  holds a certificate of authority under Chapter 844.
         (b)  This chapter applies to group health coverage made
  available by a school district in accordance with Section 22.004,
  Education Code.
         (c)  Notwithstanding any provision in Chapter 1551, 1575,
  1579, or 1601 or any other law, this chapter applies to:
               (1)  a basic coverage plan under Chapter 1551;
               (2)  a basic plan under Chapter 1575;
               (3)  a primary care coverage plan under Chapter 1579;
  and
               (4)  basic coverage under Chapter 1601.
         (d)  Notwithstanding Section 1501.251 or any other law, this
  chapter applies to coverage under a small or large employer health
  benefit plan subject to Chapter 1501.
         (e)  Notwithstanding Section 1507.003 or 1507.053 or any
  other law, this chapter applies to a standard health benefit plan
  provided under Chapter 1507.
         Sec. 1218.003.  CERTAIN COVERAGE NOT AFFECTED. This chapter
  does not apply to health benefit plan coverage provided to an
  enrollee for any abortion other than an elective abortion as
  defined by Section 1218.001.
         Sec. 1218.004.  COVERAGE REQUIREDBY HEALTH BENEFIT PLAN. A
  health benefit plan shallmay provide coverage for elective
  abortion and all FDA approved forms of contraception, including
  device insertion and removal and voluntary sterilization including
  vasectomiesonly if:not subject to
               (1)  any cost sharing for those services, including
  deductible or coinsurance. [B2]the coverage is provided to an
  enrollee separately from other health benefit plan coverage offered
  by the health benefit plan issuer;
               (2)  utilization reviewthe enrollee pays the premium
  for coverage for elective abortion separately from, and in addition
  to, the premium for other health benefit plan coverage, if any; and
               (3)  prior authorization or step-therapy requirements;
  orthe enrollee provides a signature for coverage for elective
  abortion, separately and distinct from the signature required for
  other health benefit plan coverage, if any, provided to the
  enrollee by the health benefit plan issuer.
               (4)  any restrictions or delays on the coverage.
         Sec. 1218.005.  CALCULATION OF PREMIUM. (a) A health
  benefit plan issuer that provides coverage for elective abortion
  shall calculate the premium for the coverage so that the premium
  fully covers the estimated cost of elective abortion per enrollee,
  determined on an actuarial basis.
         (b)  In calculating a premium under Subsection (a), the
  health benefit plan issuer may not take 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
  elective abortion.
         (c)  A health benefit plan issuer may not provide a premium
  discount to or reduce the premium for an enrollee for other health
  benefit plan coverage on the basis that the enrollee has coverage
  for elective abortion.
         Sec. 1218.006.  NOTICE BY ISSUER. A health benefit plan
  issuer that provides coverage for elective abortion shall at the
  time of enrollment in other health benefit plan coverage provide
  each enrollee with a notice that:
               (1)  coverage for elective abortion is optional and
  separate from other health benefit plan coverage offered by the
  health benefit plan issuer;
               (2)  the premium cost for coverage for elective
  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
               (3)  the enrollee may enroll in a health benefit plan
  without obtaining coverage for elective abortion.
         SECTION 3.  The following provisions are repealed:
               (1)  Section 32.005, Health and Safety Code;
               (2)  Section 32.024(c-1), Human Resources Code;
               (3)  Subtitle M, Title 8, Insurance Code.
         SECTION 4.  If before implementing any provision of this Act
  a state agency determines that a waiver or authorization from a
  federal agency is necessary for implementation of that provision,
  the agency affected by the provision shall request the waiver or
  authorization and may delay implementing that provision until the
  waiver or authorization is granted.
         SECTION 5.  This Act takes effect September 1, 2023.