1-1                                   AN ACT
 1-2     relating to coverage under a health benefit plan for prescription
 1-3     contraceptive drugs and devices and related services.
 1-4           BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
 1-5           SECTION 1. Subchapter E, Chapter 21, Insurance Code, is
 1-6     amended by adding Article 21.52L to read as follows:
 1-7           Art. 21.52L.  HEALTH BENEFIT PLAN COVERAGE FOR PRESCRIPTION
 1-8     CONTRACEPTIVE DRUGS AND DEVICES AND RELATED SERVICES
 1-9           Sec. 1.  GENERAL DEFINITIONS. In this article:
1-10                 (1)  "Enrollee" means any person who is entitled to
1-11     benefits under a health benefit plan.
1-12                 (2)  "Outpatient contraceptive service" means a
1-13     consultation, examination, procedure, or medical service that is
1-14     provided on an outpatient basis and that is related to the use of a
1-15     drug or device intended to prevent pregnancy.
1-16           Sec. 2.  DEFINITION OF HEALTH BENEFIT PLAN. (a)  In this
1-17     article, "health benefit plan" means a plan that provides benefits
1-18     for medical or surgical expenses incurred as a result of a health
1-19     condition, accident, or sickness, including an individual, group,
1-20     blanket, or franchise insurance policy or insurance agreement, a
1-21     group hospital service contract, or an individual or group evidence
1-22     of coverage or similar coverage document that is offered by:
1-23                 (1)  an insurance company;
1-24                 (2)  a group hospital service corporation operating
 2-1     under Chapter 20 of this code;
 2-2                 (3)  a fraternal benefit society operating under
 2-3     Chapter 10 of this code;
 2-4                 (4)  a stipulated premium insurance company operating
 2-5     under Chapter 22 of this code;
 2-6                 (5)  a reciprocal exchange operating under Chapter 19
 2-7     of this code;
 2-8                 (6)  a health maintenance organization operating under
 2-9     the Texas Health Maintenance Organization Act (Chapter 20A,
2-10     Vernon's Texas Insurance Code);
2-11                 (7)  a multiple employer welfare arrangement that holds
2-12     a certificate of authority under Article 3.95-2 of this code; or
2-13                 (8)  an approved nonprofit health corporation that
2-14     holds a certificate of authority under Article 21.52F of this code.
2-15           (b)  "Health benefit plan" includes a small employer health
2-16     benefit plan offered in accordance with Chapter 26 of this code.
2-17           (c)  "Health benefit plan" does not include:
2-18                 (1)  a plan that provides coverage only:
2-19                       (A)  for benefits for a specified disease or for
2-20     another limited benefit other than for cancer;
2-21                       (B)  for accidental death or dismemberment;
2-22                       (C)  for wages or payments in lieu of wages for a
2-23     period during which an employee is absent from work because of
2-24     sickness or injury;
2-25                       (D)  as a supplement to a liability insurance
2-26     policy;
2-27                       (E)  for credit insurance;
 3-1                       (F)  for dental or vision care; or
 3-2                       (G)  for indemnity for hospital confinement;
 3-3                 (2)  a Medicare supplemental policy as defined by
 3-4     Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss),
 3-5     as amended;
 3-6                 (3)  a workers' compensation insurance policy;
 3-7                 (4)  medical payment insurance coverage provided under
 3-8     a motor vehicle insurance policy; or
 3-9                 (5)  a long-term care insurance policy, including a
3-10     nursing home fixed indemnity policy, unless the commissioner
3-11     determines that the policy provides benefit coverage so
3-12     comprehensive that the policy is a health benefit plan as described
3-13     by Subsection (a) of this section.
3-14           Sec. 3.  PROHIBITED EXCLUSION OR LIMITATION. (a)  A health
3-15     benefit plan that provides benefits for prescription drugs or
3-16     devices may not exclude or limit benefits to enrollees for:
3-17                 (1)  a prescription contraceptive drug or device
3-18     approved by the United States Food and Drug Administration; or
3-19                 (2)  an outpatient contraceptive service.
3-20           (b)  This section does not prohibit a limitation that applies
3-21     to all prescription drugs or devices or all services for which
3-22     benefits are provided under a health benefit plan.
3-23           (c)  This section does not provide coverage for
3-24     abortifacients or any other drug or device that terminates a
3-25     pregnancy.
3-26           Sec. 4.  PROHIBITED COST-SHARING PROVISIONS. (a)  A health
3-27     benefit plan may not impose any deductible, copayment, coinsurance,
 4-1     or other cost-sharing provision applicable to benefits for
 4-2     prescription contraceptive drugs or devices unless the amount of
 4-3     the required cost-sharing does not exceed the amount of the
 4-4     required cost-sharing applicable to benefits for other prescription
 4-5     drugs or devices under the plan.
 4-6           (b)  A health benefit plan may not impose any deductible,
 4-7     copayment, coinsurance, or other cost-sharing provision applicable
 4-8     to benefits for outpatient contraceptive services unless the amount
 4-9     of the required cost-sharing does not exceed the amount of the
4-10     required cost-sharing applicable to benefits for other outpatient
4-11     services under the plan.
4-12           Sec. 5.  PROHIBITED WAITING PERIOD. (a)  A health benefit
4-13     plan may not impose any waiting period applicable to benefits for
4-14     prescription contraceptive drugs or devices unless the waiting
4-15     period is not longer than any waiting period applicable to benefits
4-16     for other prescription drugs or devices under the plan.
4-17           (b)  A health benefit plan may not impose any waiting period
4-18     applicable to benefits for outpatient contraceptive services unless
4-19     the waiting period is not longer than any waiting period applicable
4-20     to benefits for other outpatient services under the plan.
4-21           Sec. 6.  PROHIBITED CONDUCT. The issuer of a health benefit
4-22     plan may not:
4-23                 (1)  deny an applicant for enrollment or an enrollee
4-24     eligibility or continued eligibility under the plan, or deny
4-25     renewal of a plan to an enrollee, solely because of the applicant's
4-26     or enrollee's use or potential use of a prescription contraceptive
4-27     drug or device or an outpatient contraceptive service;
 5-1                 (2)  provide a monetary incentive to an applicant for
 5-2     enrollment or an enrollee to induce the applicant or enrollee to
 5-3     accept coverage that does not satisfy the requirements of this
 5-4     article; or
 5-5                 (3)  reduce or limit a payment to a health care
 5-6     professional, or otherwise penalize the professional, because the
 5-7     professional prescribes a contraceptive drug or device  or provides
 5-8     an outpatient contraceptive service.
 5-9           Sec. 7.  EXEMPTION. (a)  This article does not require a
5-10     health benefit plan that is issued by an entity associated with a
5-11     religious organization or any physician or health care provider
5-12     providing medical or health care services under the health benefit
5-13     plan to offer,  recommend, offer advice concerning, pay for,
5-14     provide, assist in, perform, arrange, or participate in providing
5-15     or performing a medical or health care service that violates the
5-16     religious convictions of the organization, except if the
5-17     prescription contraceptive coverage is necessary to preserve the
5-18     life or health of the insured individual.
5-19           (b)  The issuer of a health benefit plan that limits or
5-20     excludes coverage for medical or health care services under this
5-21     section must state the limitation or exclusion in the coverage
5-22     document, the plan's statement of benefits, brochures, and other
5-23     informational materials for the health benefit plan.
5-24           Sec. 8.  ENFORCEMENT. The issuer of a health benefit plan
5-25     that violates this article is subject to the enforcement provisions
5-26     of Subtitle B, Title 2, of this code.
5-27           SECTION 2. This Act takes effect September 1, 2001, and
 6-1     applies only to a health benefit plan that is delivered, issued for
 6-2     delivery, or renewed on or after January 1, 2002.  A plan that is
 6-3     delivered, issued for delivery, or renewed before January 1, 2002,
 6-4     is governed by the law as it existed immediately before the
 6-5     effective date of this Act, and that law is continued in effect for
 6-6     that purpose.
         _______________________________     _______________________________
             President of the Senate              Speaker of the House
               I certify that H.B. No. 2382 was passed by the House on May
         3, 2001, by a non-record vote.
                                             _______________________________
                                                 Chief Clerk of the House
               I certify that H.B. No. 2382 was passed by the Senate on May
         22, 2001, by a viva-voce vote.
                                             _______________________________
                                                 Secretary of the Senate
         APPROVED:  __________________________
                              Date
                    __________________________
                            Governor