Texas 2025 - 89th Regular

Texas House Bill HB778 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	~~89R19435~~ SCL-D
	1	+	89R3205 SCL-D
2	2		By: Leach H.B. No. 778
3		-	Substitute the following for H.B. No. 778:
4		-	By: Dean C.S.H.B. No. 778
5	3
6	4
7	5
8	6
9	7		A BILL TO BE ENTITLED
10	8		AN ACT
11	9		relating to required health benefit plan coverage for gender
12	10		transition adverse effects and reversals.
13	11		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
14	12		SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
15	13		by adding Chapter 1373 to read as follows:
16	14		CHAPTER 1373. REQUIRED COVERAGE OF GENDER TRANSITION ADVERSE
17	15		EFFECTS AND REVERSALS
18	16		Sec. 1373.001. DEFINITIONS. In this chapter:
19	17		(1) "Gender transition" means a medical process by
20	18		which an individual's anatomy, physiology, or mental state is
21	19		treated or altered, including by the removal of otherwise healthy
22	20		organs or tissue, the introduction of implants or performance of
23	21		other plastic surgery, hormone treatment, or the use of drugs,
24	22		counseling, or therapy, for the purpose of furthering or assisting
25	23		the individual's identification as a member of the opposite
26	24		biological sex or group or demographic category that does not
27	25		correspond to the individual's biological sex.
28	26		(2) "Gender transition procedure or treatment" means a
29	27		medical procedure or treatment performed or provided for the
30	28		purpose of assisting an individual with a gender transition.
31	29		Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This
32	30		chapter applies only to a health benefit plan that provides
33	31		benefits for medical or surgical expenses or pharmacy benefits
34	32		incurred as a result of a health condition, accident, or sickness,
35	33		including an individual, group, blanket, or franchise insurance
36	34		policy or insurance agreement, a group hospital service contract,
37	35		or an individual or group evidence of coverage or similar coverage
38	36		document that is issued by:
39	37		(1) an insurance company;
40	38		(2) a group hospital service corporation operating
41	39		under Chapter 842;
42	40		(3) a health maintenance organization operating under
43	41		Chapter 843;
44	42		(4) an approved nonprofit health corporation that
45	43		holds a certificate of authority under Chapter 844;
46	44		(5) a multiple employer welfare arrangement that holds
47	45		a certificate of authority under Chapter 846;
48	46		(6) a stipulated premium company operating under
49	47		Chapter 884;
50	48		(7) a fraternal benefit society operating under
51	49		Chapter 885;
52	50		(8) a Lloyd's plan operating under Chapter 941; or
53	51		(9) an exchange operating under Chapter 942.
54	52		(b) Notwithstanding any other law, this chapter applies to:
55	53		(1) a small employer health benefit plan subject to
56	54		Chapter 1501, including coverage provided through a health group
57	55		cooperative under Subchapter B of that chapter;
58	56		(2) a standard health benefit plan issued under
59	57		Chapter 1507;
60	58		(3) a basic coverage plan under Chapter 1551;
61	59		(4) a basic plan under Chapter 1575;
62	60		(5) a primary care coverage plan under Chapter 1579;
63	61		(6) a plan providing basic coverage under Chapter
64	62		1601;
65	63		(7) nonprofit agricultural organization health
66	64		benefits offered by a nonprofit agricultural organization under
67	65		Chapter 1682;
68	66		(8) alternative health benefit coverage offered by a
69	67		subsidiary of the Texas Mutual Insurance Company under Subchapter
70	68		M, Chapter 2054;
71	69		(9) group health coverage made available by a school
72	70		district in accordance with Section 22.004, Education Code;
73	71		(10) the state Medicaid program, including the
74	72		Medicaid managed care program operated under Chapter 540,
75	73		Government Code;
76	74		(11) the child health plan program under Chapter 62,
77	75		Health and Safety Code;
78	76		(12) a regional or local health care program operated
79	77		under Section 75.104, Health and Safety Code;
80	78		(13) a self-funded health benefit plan sponsored by a
81	79		professional employer organization under Chapter 91, Labor Code;
82	80		(14) county employee group health benefits provided
83	81		under Chapter 157, Local Government Code; and
84	82		(15) health and accident coverage provided by a risk
85	83		pool created under Chapter 172, Local Government Code.
86	84		(c) This chapter applies to coverage under a group health
87	85		benefit plan provided to a resident of this state regardless of
88	86		whether the group policy, agreement, or contract is delivered,
89	87		issued for delivery, or renewed in this state.
90	88		(d) This chapter does not apply to a self-funded health
91	89		benefit plan as defined by the Employee Retirement Income Security
92	90		Act of 1974 (29 U.S.C. Section 1001 et seq.).
93	91		Sec. 1373.003. REQUIRED COVERAGE. (a) A health benefit
94		-	plan that provides or has ever provided coverage for an enrollee's
95		-	gender transition procedure or treatment shall provide coverage
96		-	for, including for any applicable diagnostic or billing code:
	92	+	plan that provides coverage for an enrollee's gender transition
	93	+	procedure or treatment shall provide coverage for:
97	94		(1) all possible adverse consequences related to the
98	95		enrollee's gender transition procedure or treatment, including any
99	96		short- or long-term side effects of the procedure or treatment;
100		-	(2) any baseline and follow-up testing or screening
101		-	necessary to monitor the mental and physical health of the enrollee
102		-	on at least an annual basis without regard to the sex or gender
103		-	identity designation in the enrollee's medical record; and
104		-	(3) any procedure, treatment, or therapy necessary to
105		-	manage, reverse, reconstruct from, or recover from the enrollee's
106		-	gender transition procedure or treatment.
	97	+	(2) any testing or screening necessary to monitor the
	98	+	mental and physical health of the enrollee on at least an annual
	99	+	basis; and
	100	+	(3) any procedure or treatment necessary to reverse
	101	+	the enrollee's gender transition procedure or treatment.
107	102		(b) A health benefit plan that offers coverage for a gender
108	103		transition procedure or treatment shall also provide the coverage
109	104		described by Subsection (a) to any enrollee who has undergone a
110	105		gender transition procedure or treatment regardless of whether the
111	106		enrollee was enrolled in the plan at the time of the procedure or
112	107		treatment.
113	108		SECTION 2. If before implementing any provision of this Act
114	109		a state agency determines that a waiver or authorization from a
115	110		federal agency is necessary for implementation of that provision,
116	111		the agency affected by the provision shall request the waiver or
117	112		authorization and may delay implementing that provision until the
118	113		waiver or authorization is granted.
119	114		SECTION 3. Section 1373.003, Insurance Code, as added by
120	115		this Act, applies only to a health benefit plan that is delivered,
121	116		issued for delivery, or renewed on or after January 1, 2026.
122	117		SECTION 4. This Act takes effect September 1, 2025.