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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 perimenopause and |
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menopause medications. |
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BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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SECTION 1. Chapter 1369, Insurance Code, is amended by |
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adding Subchapter O to read as follows: |
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SUBCHAPTER O. COVERAGE OF PERIMENOPAUSE AND MENOPAUSE MEDICATIONS |
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Sec. 1369.751. 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; and |
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(5) the state Medicaid program, including the Medicaid |
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managed care program operated under Chapter 540, Government Code. |
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Sec. 1369.752. COVERAGE REQUIRED FOR PERIMENOPAUSE OR |
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MENOPAUSE MEDICATIONS. A health benefit plan that provides |
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prescription drug benefits must provide coverage for a prescription |
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drug to treat perimenopause or menopause. |
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SECTION 2. If before implementing any provision of this Act |
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a state agency determines that a waiver or authorization from a |
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federal agency is necessary for implementation of that provision, |
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the agency affected by the provision shall request the waiver or |
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authorization and may delay implementing that provision until the |
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waiver or authorization is granted. |
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SECTION 3. The changes in law made by this Act apply only to |
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a health benefit plan delivered, issued for delivery, or renewed on |
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or after January 1, 2026. |
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SECTION 4. This Act takes effect September 1, 2025. |