89R14545 SCF-D
By: Shofner H.B. No. 3735
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for prenatal care,
childbirth, and postnatal care provided in a hospital, birthing
center, or home setting.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1366, Insurance Code, is amended by
adding Subchapter D to read as follows:
SUBCHAPTER D. COVERAGE FOR PRENATAL CARE, CHILDBIRTH, AND POSTNATAL
CARE
Sec. 1366.151. DEFINITION. In this subchapter, "birthing
center" has the meaning assigned by Section 244.002, Health and
Safety Code.
Sec. 1366.152. APPLICABILITY OF SUBCHAPTER. (a) This
subchapter applies only to a health benefit plan that provides
benefits for medical, surgical, or prescription drug 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 issued by:
(1) an insurance company;
(2) a group hospital service corporation operating
under Chapter 842;
(3) a health maintenance organization operating under
Chapter 843;
(4) an approved nonprofit health corporation that
holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds
a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under
Chapter 884;
(7) a fraternal benefit society operating under
Chapter 885;
(8) a Lloyd's plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
(b) Notwithstanding any other law, this subchapter 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;
(4) a plan providing basic coverage under Chapter
1601;
(5) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(6) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
Sec. 1366.153. COVERAGE REQUIRED. (a) A health benefit
plan that provides maternity benefits must provide coverage for
prenatal care, childbirth, and postnatal care provided in a
hospital, birthing center, or home setting.
(b) The coverage required under this section includes:
(1) prenatal care, childbirth, and postnatal care
provided by a nurse midwife licensed as an advanced practice
registered nurse;
(2) prenatal care visits, including an ultrasound,
dating scan, or anatomy scan;
(3) glucose, blood, and urine tests related to
prenatal care, childbirth, and postnatal care;
(4) childbirth in a hospital, birthing center, or home
setting;
(5) prescription drugs related to childbirth,
including prescription drugs related to pain management during
labor;
(6) newborn screening and hearing tests; and
(7) vitamin K injections, hepatitis B vaccines, and
antibiotic eye ointment provided to a newborn.
SECTION 2. Subchapter D, Chapter 1366, Insurance Code, as
added by this Act, applies only to a health benefit plan delivered,
issued for delivery, or renewed on or after January 1, 2026.
SECTION 3. This Act takes effect September 1, 2025.