82R1614 TRH-F
By: Hegar S.B. No. 404
A BILL TO BE ENTITLED
AN ACT
relating to health plan and health benefit plan coverage for
abortions.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Title 8, Insurance Code, is amended by adding
Subtitle K to read as follows:
SUBTITLE K. FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT
CHAPTER 1671. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS
Sec. 1671.001. DEFINITIONS. In this chapter:
(1) "Abortion" has the meaning assigned by Section
171.002, Health and Safety Code.
(2) "Health benefit exchange" means an American Health
Benefit Exchange administered by the federal government or created
pursuant to Section 1311(b) of the Patient Protection and
Affordable Care Act (Pub. L. No. 111-148).
(3) "Qualified health plan" has the meaning assigned
by Section 1301(a) of the Patient Protection and Affordable Care
Act (Pub. L. No. 111-148).
Sec. 1671.002. PROHIBITED COVERAGE THROUGH HEALTH BENEFIT
EXCHANGE. (a) A qualified health plan offered through a health
benefit exchange may not provide coverage for an abortion other
than coverage for an abortion performed when a condition exists,
based on the performing physician's good faith clinical judgment,
that complicates the medical condition of the pregnant woman and
necessitates the abortion of her pregnancy to avert her death.
(b) This section does not prevent a person from purchasing
optional supplemental coverage for abortions under Section
1218.003.
SECTION 2. Subtitle A, Title 8, Insurance Code, is amended
by adding Chapter 1218 to read as follows:
CHAPTER 1218. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS
Sec. 1218.001. DEFINITION. In this chapter, "abortion" has
the meaning assigned 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 Section 172.014, Local Government Code,
or any other law, this chapter applies to health and accident
coverage provided by a risk pool created under Chapter 172, Local
Government Code.
(d) 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.
(e) 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.
(f) Notwithstanding Section 1507.003 or 1507.053, this
chapter applies to a standard health benefit plan provided under
Chapter 1507.
Sec. 1218.003. COVERAGE BY HEALTH BENEFIT PLAN. (a) Except
as provided by Subsection (b), a health benefit plan may provide
coverage for abortion only if:
(1) the coverage is provided to an enrollee separately
from other health benefit plan coverage offered by the health
benefit plan issuer;
(2) an enrollee pays separately from, and in addition
to, the premium for other health benefit plan coverage a premium for
coverage for abortion; and
(3) an enrollee provides a signature for coverage for
abortion, separately and distinct from the signature required for
other health benefit plan coverage offered by the health benefit
plan issuer.
(b) Notwithstanding Subsection (a), a health benefit plan
may provide coverage for an abortion performed when a condition
exists, based on the performing physician's good faith clinical
judgment, that complicates the condition of a pregnant enrollee and
necessitates the abortion to avert the enrollee's death.
Sec. 1218.004. CALCULATION OF PREMIUM. (a) A health
benefit plan issuer that provides coverage for abortion shall
calculate the premium for the coverage so that the premium fully
covers the estimated cost of abortion per enrollee, determined on
an average 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
abortion, including costs associated with prenatal care, delivery,
or postnatal care.
(c) A health benefit plan issuer that provides coverage
other than coverage for abortion may not provide a premium discount
to or reduce the premium for an enrollee for coverage other than
coverage for abortion on the basis that the enrollee has health
benefit plan coverage for abortion.
Sec. 1218.005. NOTICE BY ISSUER. A health benefit plan
issuer that provides coverage for abortion shall at the time of
enrollment in the health benefit plan provide each enrollee with a
notice that:
(1) coverage for 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 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
that provides coverage other than coverage for abortion without
obtaining coverage for abortion.
Sec. 1218.006. ACCEPTANCE OR REJECTION OF COVERAGE BY
EMPLOYEES AND GROUP MEMBERS. If a small or large employer health
benefit plan or group health benefit plan offers coverage for
abortion, the employer offering the employee health benefit plan or
the entity offering the group health benefit plan shall provide
each employee or group member with an opportunity to accept or
reject coverage for abortion:
(1) at the beginning of employment or when the group
member's coverage begins, as applicable; and
(2) at least one time in each calendar year after the
first year of employment or group coverage.
SECTION 3. This Act applies only to a qualified health plan
offered through a health benefit exchange or a health benefit plan
that is delivered, issued for delivery, or renewed on or after
January 1, 2012. A qualified health plan offered through a health
benefit exchange or a health benefit plan that is delivered, issued
for delivery, or renewed before January 1, 2012, is governed by the
law as it existed immediately before the effective date of this Act,
and that law is continued in effect for that purpose.
SECTION 4. This Act takes effect September 1, 2011.