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A BILL TO BE ENTITLED
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AN ACT
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relating to health benefit plan coverage for prenatal care, |
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childbirth, and postnatal care provided in a hospital, birthing |
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center, or home setting. |
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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 D to read as follows: |
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SUBCHAPTER D. COVERAGE FOR PRENATAL CARE, CHILDBIRTH, AND POSTNATAL |
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CARE |
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Sec. 1366.151. DEFINITION. In this subchapter, "birthing |
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center" has the meaning assigned by Section 244.002, Health and |
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Safety Code. |
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Sec. 1366.152. 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, surgical, or prescription drug expenses |
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incurred as a result of a health condition, accident, or sickness, |
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including an individual, group, blanket, or franchise insurance |
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policy or insurance agreement, a group hospital service contract, |
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or an individual or group evidence of coverage or similar coverage |
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document that is issued 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 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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(4) a plan providing basic coverage under Chapter |
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1601; |
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(5) county employee group health benefits provided |
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under Chapter 157, Local Government Code; and |
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(6) health and accident coverage provided by a risk |
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pool created under Chapter 172, Local Government Code. |
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Sec. 1366.153. COVERAGE REQUIRED. (a) A health benefit |
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plan that provides maternity benefits must provide coverage for |
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prenatal care, childbirth, and postnatal care provided in a |
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hospital, birthing center, or home setting. |
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(b) The coverage required under this section includes: |
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(1) prenatal care, childbirth, and postnatal care |
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provided by a nurse midwife licensed as an advanced practice |
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registered nurse; |
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(2) prenatal care visits, including an ultrasound, |
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dating scan, or anatomy scan; |
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(3) glucose, blood, and urine tests related to |
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prenatal care, childbirth, and postnatal care; |
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(4) childbirth in a hospital, birthing center, or home |
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setting; |
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(5) prescription drugs related to childbirth, |
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including prescription drugs related to pain management during |
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labor; |
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(6) newborn screening and hearing tests; and |
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(7) vitamin K injections, hepatitis B vaccines, and |
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antibiotic eye ointment provided to a newborn. |
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SECTION 2. Subchapter D, Chapter 1366, Insurance Code, as |
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added by this Act, applies only to a health benefit plan delivered, |
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issued for delivery, or renewed on or after January 1, 2026. |
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SECTION 3. This Act takes effect September 1, 2025. |