| 1 | 1 | | 85R25826 MEW-D |
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| 2 | 2 | | By: Davis of Harris, Howard H.B. No. 1161 |
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| 3 | 3 | | Substitute the following for H.B. No. 1161: |
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| 4 | 4 | | By: Phillips C.S.H.B. No. 1161 |
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| 5 | 5 | | |
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| 6 | 6 | | |
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| 7 | 7 | | A BILL TO BE ENTITLED |
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| 8 | 8 | | AN ACT |
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| 9 | 9 | | relating to health benefit plan coverage of prescription |
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| 10 | 10 | | contraceptive drugs. |
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| 11 | 11 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 12 | 12 | | SECTION 1. Section 1369.102, Insurance Code, is amended to |
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| 13 | 13 | | read as follows: |
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| 14 | 14 | | Sec. 1369.102. APPLICABILITY OF SUBCHAPTER. Except as |
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| 15 | 15 | | otherwise provided by this subchapter, this [This] subchapter |
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| 16 | 16 | | applies only to a health benefit plan, including a small employer |
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| 17 | 17 | | health benefit plan written under Chapter 1501, that provides |
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| 18 | 18 | | benefits for medical or surgical expenses incurred as a result of a |
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| 19 | 19 | | health condition, accident, or sickness, including an individual, |
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| 20 | 20 | | group, blanket, or franchise insurance policy or insurance |
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| 21 | 21 | | agreement, a group hospital service contract, or an individual or |
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| 22 | 22 | | group evidence of coverage or similar coverage document that is |
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| 23 | 23 | | offered by: |
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| 24 | 24 | | (1) an insurance company; |
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| 25 | 25 | | (2) a group hospital service corporation operating |
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| 26 | 26 | | under Chapter 842; |
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| 27 | 27 | | (3) a fraternal benefit society operating under |
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| 28 | 28 | | Chapter 885; |
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| 29 | 29 | | (4) a stipulated premium company operating under |
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| 30 | 30 | | Chapter 884; |
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| 31 | 31 | | (5) a reciprocal exchange operating under Chapter 942; |
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| 32 | 32 | | (6) a health maintenance organization operating under |
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| 33 | 33 | | Chapter 843; |
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| 34 | 34 | | (7) a multiple employer welfare arrangement that holds |
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| 35 | 35 | | a certificate of authority under Chapter 846; or |
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| 36 | 36 | | (8) an approved nonprofit health corporation that |
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| 37 | 37 | | holds a certificate of authority under Chapter 844. |
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| 38 | 38 | | SECTION 2. Subchapter C, Chapter 1369, Insurance Code, is |
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| 39 | 39 | | amended by adding Section 1369.1031 to read as follows: |
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| 40 | 40 | | Sec. 1369.1031. CERTAIN COVERAGE REQUIRED. (a) This |
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| 41 | 41 | | section applies to a health benefit plan described by Section |
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| 42 | 42 | | 1369.102. |
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| 43 | 43 | | (b) This section applies to group health coverage made |
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| 44 | 44 | | available by a school district in accordance with Section 22.004, |
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| 45 | 45 | | Education Code. |
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| 46 | 46 | | (c) Notwithstanding any provision in Chapter 1551, 1575, |
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| 47 | 47 | | 1579, or 1601 or any other law, this section applies to: |
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| 48 | 48 | | (1) a basic coverage plan under Chapter 1551; |
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| 49 | 49 | | (2) a basic plan under Chapter 1575; |
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| 50 | 50 | | (3) a primary care coverage plan under Chapter 1579; |
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| 51 | 51 | | and |
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| 52 | 52 | | (4) basic coverage under Chapter 1601. |
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| 53 | 53 | | (d) Notwithstanding Sections 1507.004 and 1507.053, or any |
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| 54 | 54 | | other law, this section applies to a consumer choice of benefits |
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| 55 | 55 | | plan issued under Chapter 1507. |
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| 56 | 56 | | (e) To the extent allowed by federal law, the child health |
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| 57 | 57 | | plan program operated under Chapter 62, Health and Safety Code, the |
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| 58 | 58 | | health benefits plan for children operated under Chapter 63, Health |
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| 59 | 59 | | and Safety Code, the state Medicaid program, and a managed care |
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| 60 | 60 | | organization that contracts with the Health and Human Services |
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| 61 | 61 | | Commission to provide health care services to recipients through a |
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| 62 | 62 | | managed care plan shall provide the coverage required under this |
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| 63 | 63 | | section to a recipient. |
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| 64 | 64 | | (f) A health benefit plan that provides benefits for a |
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| 65 | 65 | | prescription contraceptive drug must provide for an enrollee to |
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| 66 | 66 | | obtain up to: |
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| 67 | 67 | | (1) a 3-month supply of the covered prescription |
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| 68 | 68 | | contraceptive drug at one time the first time the enrollee obtains |
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| 69 | 69 | | the drug; and |
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| 70 | 70 | | (2) a 12-month supply of the covered prescription |
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| 71 | 71 | | contraceptive drug at one time each subsequent time the enrollee |
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| 72 | 72 | | obtains the same drug, regardless of whether the enrollee was |
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| 73 | 73 | | enrolled in the health benefit plan the first time the enrollee |
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| 74 | 74 | | obtained the drug. |
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| 75 | 75 | | (g) An enrollee may obtain only one 12-month supply of a |
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| 76 | 76 | | covered prescription contraceptive drug during each 12-month |
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| 77 | 77 | | period. |
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| 78 | 78 | | SECTION 3. The change in law made by this Act applies only |
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| 79 | 79 | | to a health benefit plan that is delivered, issued for delivery, or |
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| 80 | 80 | | renewed on or after January 1, 2018. A health benefit plan that is |
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| 81 | 81 | | delivered, issued for delivery, or renewed before January 1, 2018, |
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| 82 | 82 | | is governed by the law as it existed immediately before the |
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| 83 | 83 | | effective date of this Act, and that law is continued in effect for |
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| 84 | 84 | | that purpose. |
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| 85 | 85 | | SECTION 4. This Act takes effect September 1, 2017. |
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