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