89R14910 SCF-D
By: Pierson H.B. No. 3814
A BILL TO BE ENTITLED
AN ACT
relating to health benefit plan coverage for perimenopause and
menopause medications.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Chapter 1369, Insurance Code, is amended by
adding Subchapter O to read as follows:
SUBCHAPTER O. COVERAGE OF PERIMENOPAUSE AND MENOPAUSE MEDICATIONS
Sec. 1369.751. 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; and
(5) the state Medicaid program, including the Medicaid
managed care program operated under Chapter 540, Government Code.
Sec. 1369.752. COVERAGE REQUIRED FOR PERIMENOPAUSE OR
MENOPAUSE MEDICATIONS. A health benefit plan that provides
prescription drug benefits must provide coverage for a prescription
drug to treat perimenopause or menopause.
SECTION 2. If before implementing any provision of this Act
a state agency determines that a waiver or authorization from a
federal agency is necessary for implementation of that provision,
the agency affected by the provision shall request the waiver or
authorization and may delay implementing that provision until the
waiver or authorization is granted.
SECTION 3. The changes in law made by this Act apply only to
a health benefit plan delivered, issued for delivery, or renewed on
or after January 1, 2026.
SECTION 4. This Act takes effect September 1, 2025.