Texas 2013 - 83rd Regular

Texas House Bill HB997 Compare Versions

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1	1	83R6837 TJS-F
2	2	By: Smithee, Flynn, Thompson of Brazoria, H.B. No. 997
3	3	Bonnen of Brazoria, Bonnen of Galveston,
4	4
5	5
6	6	A BILL TO BE ENTITLED
7	7	AN ACT
8	8	relating to health plan and health benefit plan coverage for
9	9	abortions.
10	10	BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	11	SECTION 1. Title 8, Insurance Code, is amended by adding
12	12	Subtitle K to read as follows:
13	13	SUBTITLE K. FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT
14	14	CHAPTER 1671. LEGISLATIVE CONSIDERATIONS
15	15	Sec. 1671.001. CONSTITUTIONALITY OF PATIENT PROTECTION AND
16	16	AFFORDABLE CARE ACT. This subtitle does not constitute an
17	17	acknowledgment by the legislature of the legitimacy of the Patient
18	18	Protection and Affordable Care Act (Pub. L. No. 111-148) as a
19	19	constitutional exercise of the power of the United States Congress.
20	20	CHAPTER 1672. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS
21	21	Sec. 1672.001. DEFINITIONS. In this chapter:
22	22	(1) "Abortion" has the meaning assigned by Section
23	23	171.002, Health and Safety Code.
24	24	(2) "Health benefit exchange" means an American Health
25	25	Benefit Exchange administered by the federal government or created
26	26	under Section 1311(b) of the Patient Protection and Affordable Care
27	27	Act (42 U.S.C. Section 18031(b)).
28	28	(3) "Qualified health plan" has the meaning assigned
29	29	by Section 1301(a) of the Patient Protection and Affordable Care
30	30	Act (42 U.S.C. Section 18021(a)).
31	31	Sec. 1672.002. PROHIBITED COVERAGE THROUGH HEALTH BENEFIT
32	32	EXCHANGE. (a) A qualified health plan offered through a health
33	33	benefit exchange may not provide coverage for an abortion other
34	34	than coverage for an abortion performed when a life-threatening
35	35	physical condition exists, based on reasonable medical judgment,
36	36	that complicates the medical condition of the pregnant woman or
37	37	pregnant minor to an extent that the abortion of her pregnancy is
38	38	necessary to prevent her death or a serious risk of substantial and
39	39	irreversible physical impairment of a major bodily function of the
40	40	woman or minor, other than a psychological or emotional condition.
41	41	(b) Subsection (a) does not authorize coverage for an
42	42	abortion based on a potential future medical condition that may
43	43	result from a voluntary act of the woman or minor.
44	44	(c) This section does not prevent a person from purchasing
45	45	optional or supplemental coverage for abortions under a health
46	46	benefit plan other than a qualified health plan offered through a
47	47	health benefit exchange.
48	48	SECTION 2. Subtitle A, Title 8, Insurance Code, is amended
49	49	by adding Chapter 1218 to read as follows:
50	50	CHAPTER 1218. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS
51	51	Sec. 1218.001. DEFINITION. In this chapter, "abortion" has
52	52	the meaning assigned by Section 171.002, Health and Safety Code.
53	53	Sec. 1218.002. APPLICABILITY OF CHAPTER. (a) This chapter
54	54	applies only to a health benefit plan that provides benefits for
55	55	medical or surgical expenses incurred as a result of a health
56	56	condition, accident, or sickness, including an individual, group,
57	57	blanket, or franchise insurance policy or insurance agreement, a
58	58	group hospital service contract, or an individual or group evidence
59	59	of coverage or similar coverage document that is offered by:
60	60	(1) an insurance company;
61	61	(2) a group hospital service corporation operating
62	62	under Chapter 842;
63	63	(3) a fraternal benefit society operating under
64	64	Chapter 885;
65	65	(4) a stipulated premium company operating under
66	66	Chapter 884;
67	67	(5) an exchange operating under Chapter 942;
68	68	(6) a health maintenance organization operating under
69	69	Chapter 843;
70	70	(7) a multiple employer welfare arrangement that holds
71	71	a certificate of authority under Chapter 846; or
72	72	(8) an approved nonprofit health corporation that
73	73	holds a certificate of authority under Chapter 844.
74	74	(b) This chapter applies to group health coverage made
75	75	available by a school district in accordance with Section 22.004,
76	76	Education Code.
77	77	(c) Notwithstanding Section 172.014, Local Government Code,
78	78	or any other law, this chapter applies to health and accident
79	79	coverage provided by a risk pool created under Chapter 172, Local
80	80	Government Code.
81	81	(d) Notwithstanding any provision in Chapter 1551, 1575,
82	82	1579, or 1601 or any other law, this chapter applies to:
83	83	(1) a basic coverage plan under Chapter 1551;
84	84	(2) a basic plan under Chapter 1575;
85	85	(3) a primary care coverage plan under Chapter 1579;
86	86	and
87	87	(4) basic coverage under Chapter 1601.
88	88	(e) Notwithstanding Section 1501.251 or any other law, this
89	89	chapter applies to coverage under a small or large employer health
90	90	benefit plan subject to Chapter 1501.
91	91	(f) Notwithstanding Section 1507.003 or 1507.053, this
92	92	chapter applies to a standard health benefit plan provided under
93	93	Chapter 1507.
94	94	Sec. 1218.003. COVERAGE BY HEALTH BENEFIT PLAN. (a) Except
95	95	as provided by Subsection (b), a health benefit plan may provide
96	96	coverage for abortion only if:
97	97	(1) the coverage is provided to an enrollee separately
98	98	from other health benefit plan coverage offered by the health
99	99	benefit plan issuer;
100	100	(2) an enrollee pays separately from, and in addition
101	101	to, the premium for other health benefit plan coverage a premium for
102	102	coverage for abortion; and
103	103	(3) an enrollee provides a signature for coverage for
104	104	abortion, separately and distinct from the signature required for
105	105	other health benefit plan coverage offered by the health benefit
106	106	plan issuer.
107	107	(b) Notwithstanding Subsection (a), a health benefit plan
108	108	may provide coverage for an abortion performed when a
109	109	life-threatening physical condition exists, based on the
110	110	performing physician's reasonable medical judgment, that
111	111	complicates the medical condition of a pregnant enrollee to the
112	112	extent that the abortion of her pregnancy is necessary to prevent
113	113	her death or a serious risk of substantial and irreversible
114	114	physical impairment of a major bodily function of the enrollee,
115	115	other than a psychological or emotional condition.
116	116	(c) Subsection (b) does not authorize coverage for an
117	117	abortion based on a potential future medical condition that may
118	118	result from a voluntary act of the enrollee.
119	119	Sec. 1218.004. CALCULATION OF PREMIUM. (a) A health
120	120	benefit plan issuer that provides coverage for abortion shall
121	121	calculate the premium for the coverage so that the premium fully
122	122	covers the estimated cost of abortion per enrollee, determined on
123	123	an average actuarial basis.
124	124	(b) In calculating a premium under Subsection (a), the
125	125	health benefit plan issuer may not take into account any cost
126	126	savings in other health benefit plan coverage offered by the health
127	127	benefit plan issuer that is estimated to result from coverage for
128	128	abortion, including costs associated with prenatal care, delivery,
129	129	or postnatal care.
130	130	(c) A health benefit plan issuer that provides coverage
131	131	other than coverage for abortion may not provide a premium discount
132	132	to or reduce the premium for an enrollee for coverage other than
133	133	coverage for abortion on the basis that the enrollee has health
134	134	benefit plan coverage for abortion.
135	135	Sec. 1218.005. NOTICE BY ISSUER. A health benefit plan
136	136	issuer that provides coverage for abortion shall at the time of
137	137	enrollment in the health benefit plan provide each enrollee with a
138	138	notice that:
139	139	(1) coverage for abortion is optional and separate
140	140	from other health benefit plan coverage offered by the health
141	141	benefit plan issuer;
142	142	(2) the premium cost for coverage for abortion is a
143	143	premium paid separately from, and in addition to, the premium for
144	144	other health benefit plan coverage offered by the health benefit
145	145	plan issuer; and
146	146	(3) the enrollee may enroll in a health benefit plan
147	147	that provides coverage other than coverage for abortion without
148	148	obtaining coverage for abortion.
149	149	Sec. 1218.006. ACCEPTANCE OR REJECTION OF SUPPLEMENTAL
150	150	COVERAGE BY EMPLOYEES AND GROUP MEMBERS. If a small or large
151	151	employer health benefit plan or group health benefit plan offers
152	152	coverage for abortion, the employer offering the employee health
153	153	benefit plan or the entity offering the group health benefit plan
154	154	shall provide each employee or group member with an opportunity to
155	155	accept or reject supplemental coverage for abortion:
156	156	(1) at the beginning of employment or when the group
157	157	member's coverage begins, as applicable; and
158	158	(2) at least one time in each calendar year after the
159	159	first year of employment or group coverage.
160	160	SECTION 3. This Act applies only to a qualified health plan
161	161	offered through a health benefit exchange or a health benefit plan
162	162	that is delivered, issued for delivery, or renewed on or after
163	163	January 1, 2014. A qualified health plan offered through a health
164	164	benefit exchange or a health benefit plan that is delivered, issued
165	165	for delivery, or renewed before January 1, 2014, is governed by the
166	166	law as it existed immediately before the effective date of this Act,
167	167	and that law is continued in effect for that purpose.
168	168	SECTION 4. This Act takes effect September 1, 2013.