| 1 | 1 | | 89R14545 SCF-D |
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| 2 | 2 | | By: Shofner H.B. No. 3735 |
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| 3 | 3 | | |
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| 4 | 4 | | |
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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 for prenatal care, |
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| 10 | 10 | | childbirth, and postnatal care provided in a hospital, birthing |
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| 11 | 11 | | center, or home setting. |
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| 12 | 12 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 13 | 13 | | SECTION 1. Chapter 1366, Insurance Code, is amended by |
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| 14 | 14 | | adding Subchapter D to read as follows: |
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| 15 | 15 | | SUBCHAPTER D. COVERAGE FOR PRENATAL CARE, CHILDBIRTH, AND POSTNATAL |
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| 16 | 16 | | CARE |
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| 17 | 17 | | Sec. 1366.151. DEFINITION. In this subchapter, "birthing |
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| 18 | 18 | | center" has the meaning assigned by Section 244.002, Health and |
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| 19 | 19 | | Safety Code. |
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| 20 | 20 | | Sec. 1366.152. APPLICABILITY OF SUBCHAPTER. (a) This |
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| 21 | 21 | | subchapter applies only to a health benefit plan that provides |
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| 22 | 22 | | benefits for medical, surgical, or prescription drug expenses |
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| 23 | 23 | | incurred as a result of a health condition, accident, or sickness, |
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| 24 | 24 | | including an individual, group, blanket, or franchise insurance |
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| 25 | 25 | | policy or insurance agreement, a group hospital service contract, |
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| 26 | 26 | | or an individual or group evidence of coverage or similar coverage |
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| 27 | 27 | | document that is issued by: |
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| 28 | 28 | | (1) an insurance company; |
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| 29 | 29 | | (2) a group hospital service corporation operating |
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| 30 | 30 | | under Chapter 842; |
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| 31 | 31 | | (3) a health maintenance organization operating under |
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| 32 | 32 | | Chapter 843; |
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| 33 | 33 | | (4) an approved nonprofit health corporation that |
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| 34 | 34 | | holds a certificate of authority under Chapter 844; |
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| 35 | 35 | | (5) a multiple employer welfare arrangement that holds |
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| 36 | 36 | | a certificate of authority under Chapter 846; |
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| 37 | 37 | | (6) a stipulated premium company operating under |
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| 38 | 38 | | Chapter 884; |
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| 39 | 39 | | (7) a fraternal benefit society operating under |
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| 40 | 40 | | Chapter 885; |
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| 41 | 41 | | (8) a Lloyd's plan operating under Chapter 941; or |
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| 42 | 42 | | (9) an exchange operating under Chapter 942. |
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| 43 | 43 | | (b) Notwithstanding any other law, this subchapter applies |
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| 44 | 44 | | to: |
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| 45 | 45 | | (1) a basic coverage plan under Chapter 1551; |
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| 46 | 46 | | (2) a basic plan under Chapter 1575; |
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| 47 | 47 | | (3) a primary care coverage plan under Chapter 1579; |
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| 48 | 48 | | (4) a plan providing basic coverage under Chapter |
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| 49 | 49 | | 1601; |
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| 50 | 50 | | (5) county employee group health benefits provided |
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| 51 | 51 | | under Chapter 157, Local Government Code; and |
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| 52 | 52 | | (6) health and accident coverage provided by a risk |
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| 53 | 53 | | pool created under Chapter 172, Local Government Code. |
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| 54 | 54 | | Sec. 1366.153. COVERAGE REQUIRED. (a) A health benefit |
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| 55 | 55 | | plan that provides maternity benefits must provide coverage for |
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| 56 | 56 | | prenatal care, childbirth, and postnatal care provided in a |
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| 57 | 57 | | hospital, birthing center, or home setting. |
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| 58 | 58 | | (b) The coverage required under this section includes: |
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| 59 | 59 | | (1) prenatal care, childbirth, and postnatal care |
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| 60 | 60 | | provided by a nurse midwife licensed as an advanced practice |
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| 61 | 61 | | registered nurse; |
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| 62 | 62 | | (2) prenatal care visits, including an ultrasound, |
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| 63 | 63 | | dating scan, or anatomy scan; |
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| 64 | 64 | | (3) glucose, blood, and urine tests related to |
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| 65 | 65 | | prenatal care, childbirth, and postnatal care; |
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| 66 | 66 | | (4) childbirth in a hospital, birthing center, or home |
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| 67 | 67 | | setting; |
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| 68 | 68 | | (5) prescription drugs related to childbirth, |
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| 69 | 69 | | including prescription drugs related to pain management during |
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| 70 | 70 | | labor; |
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| 71 | 71 | | (6) newborn screening and hearing tests; and |
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| 72 | 72 | | (7) vitamin K injections, hepatitis B vaccines, and |
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| 73 | 73 | | antibiotic eye ointment provided to a newborn. |
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| 74 | 74 | | SECTION 2. Subchapter D, Chapter 1366, Insurance Code, as |
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| 75 | 75 | | added by this Act, applies only to a health benefit plan delivered, |
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| 76 | 76 | | issued for delivery, or renewed on or after January 1, 2026. |
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| 77 | 77 | | SECTION 3. This Act takes effect September 1, 2025. |
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