| 3 | 5 | | |
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| 4 | 6 | | |
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| 5 | 7 | | A BILL TO BE ENTITLED |
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| 6 | 8 | | AN ACT |
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| 7 | 9 | | relating to health benefit plan coverage of certain in vitro |
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| 8 | 10 | | fertilization procedures for certain governmental employees and |
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| 9 | 11 | | retirees. |
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| 10 | 12 | | BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: |
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| 11 | 13 | | SECTION 1. Section 1366.001, Insurance Code, is amended to |
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| 12 | 14 | | read as follows: |
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| 13 | 15 | | Sec. 1366.001. APPLICABILITY OF SUBCHAPTER. Except as |
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| 14 | 16 | | otherwise provided by this subchapter, this [This] subchapter |
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| 15 | 17 | | applies only to a group health benefit plan that provides benefits |
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| 16 | 18 | | for hospital, medical, or surgical expenses incurred as a result of |
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| 17 | 19 | | accident or sickness, including a group health insurance policy, |
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| 18 | 20 | | health care service contract or plan, or other provision of group |
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| 19 | 21 | | health benefits, coverage, or services in this state that is |
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| 20 | 22 | | issued, entered into, or provided by: |
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| 21 | 23 | | (1) an insurer; |
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| 22 | 24 | | (2) a group hospital service corporation operating |
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| 23 | 25 | | under Chapter 842; |
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| 24 | 26 | | (3) a health maintenance organization operating under |
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| 25 | 27 | | Chapter 843; or |
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| 26 | 28 | | (4) an employer, multiple employer, union, |
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| 27 | 29 | | association, trustee, or other self-funded or self-insured welfare |
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| 28 | 30 | | or benefit plan, program, or arrangement. |
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| 29 | 31 | | SECTION 2. Subchapter A, Chapter 1366, Insurance Code, is |
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| 30 | 32 | | amended by adding Section 1366.0045 to read as follows: |
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| 31 | 33 | | Sec. 1366.0045. COVERAGE FOR CERTAIN GOVERNMENTAL |
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| 32 | 34 | | EMPLOYEES AND RETIREES. (a) Notwithstanding any other law, this |
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| 33 | 35 | | section applies only to: |
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| 34 | 36 | | (1) a basic coverage plan under Chapter 1551; |
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| 35 | 37 | | (2) a basic plan under Chapter 1575; |
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| 36 | 38 | | (3) a primary care coverage plan under Chapter 1579; |
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| 37 | 39 | | and |
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| 38 | 40 | | (4) a plan providing basic coverage under Chapter |
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| 39 | 41 | | 1601. |
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| 40 | 42 | | (b) Subject to Section 1366.005, a health benefit plan that |
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| 41 | 43 | | provides pregnancy-related benefits for individuals covered under |
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| 42 | 44 | | the plan must provide coverage for outpatient expenses that arise |
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| 43 | 45 | | from in vitro fertilization procedures. |
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| 44 | 46 | | (c) A health benefit plan must provide benefits for in vitro |
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| 45 | 47 | | fertilization procedures required under this section to the same |
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| 46 | 48 | | extent that the plan provides benefits for other pregnancy-related |
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| 47 | 49 | | procedures. |
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| 48 | 50 | | SECTION 3. Section 1366.005, Insurance Code, is amended to |
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| 49 | 51 | | read as follows: |
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| 50 | 52 | | Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE. The |
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| 51 | 53 | | coverage offered under Section 1366.003 or provided under Section |
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| 52 | 54 | | 1366.0045 is required to be offered or provided only if: |
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| 53 | 55 | | (1) the patient for the in vitro fertilization |
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| 54 | 56 | | procedure is an individual covered under the group health benefit |
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| 55 | 57 | | plan; |
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| 56 | 58 | | (2) the fertilization or attempted fertilization of |
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| 57 | 59 | | the patient's oocytes is made only with the sperm of the patient's |
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| 58 | 60 | | spouse; |
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| 59 | 61 | | (3) the patient and the patient's spouse have a history |
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| 60 | 62 | | of infertility of at least five continuous years' duration or the |
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| 61 | 63 | | infertility is associated with: |
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| 62 | 64 | | (A) endometriosis; |
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| 63 | 65 | | (B) exposure in utero to diethylstilbestrol |
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| 64 | 66 | | (DES); |
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| 65 | 67 | | (C) blockage of or surgical removal of one or |
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| 66 | 68 | | both fallopian tubes; or |
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| 67 | 69 | | (D) oligospermia; |
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| 68 | 70 | | (4) the patient has been unable to attain a successful |
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| 69 | 71 | | pregnancy through any less costly applicable infertility |
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| 70 | 72 | | treatments for which coverage is available under the group health |
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| 71 | 73 | | benefit plan; and |
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| 72 | 74 | | (5) the in vitro fertilization procedures are |
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| 73 | 75 | | performed at a medical facility that conforms to the minimal |
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| 74 | 76 | | standards for programs of in vitro fertilization adopted by the |
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| 75 | 77 | | American Society for Reproductive Medicine. |
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| 76 | 78 | | SECTION 4. Subchapter A, Chapter 1366, Insurance Code, as |
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| 77 | 79 | | amended by this Act, applies only to a health benefit plan that is |
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| 78 | 80 | | delivered, issued for delivery, or renewed on or after January 1, |
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| 79 | 81 | | 2026. A health benefit plan delivered, issued for delivery, or |
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| 80 | 82 | | renewed before January 1, 2026, is governed by the law as it existed |
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| 81 | 83 | | immediately before the effective date of this Act, and that law is |
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| 82 | 84 | | continued in effect for that purpose. |
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| 83 | 85 | | SECTION 5. This Act takes effect September 1, 2025. |
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