Texas 2025 - 89th Regular

Texas Senate Bill SB1257 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	By: Hughes, Hall, Sparks S.B. No. 1257
2		-
3		-
	1	+	By: Hughes S.B. No. 1257
	2	+	(In the Senate - Filed February 13, 2025; February 28, 2025,
	3	+	read first time and referred to Committee on Health & Human
	4	+	Services; April 7, 2025, reported adversely, with favorable
	5	+	Committee Substitute by the following vote: Yeas 6, Nays 3;
	6	+	April 7, 2025, sent to printer.)
	7	+	Click here to see the committee vote
	8	+	COMMITTEE SUBSTITUTE FOR S.B. No. 1257 By: Perry
4	9
5	10
6	11		A BILL TO BE ENTITLED
7	12		AN ACT
8	13		relating to required health benefit plan coverage for gender
9	14		transition adverse effects and reversals.
10	15		BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
11	16		SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
12	17		by adding Chapter 1373 to read as follows:
13	18		CHAPTER 1373. REQUIRED COVERAGE OF GENDER TRANSITION ADVERSE
14	19		EFFECTS AND REVERSALS
15	20		Sec. 1373.001. DEFINITIONS. In this chapter:
16	21		(1) "Gender transition" means a medical process by
17	22		which an individual's anatomy, physiology, or mental state is
18	23		treated or altered, including by the removal of otherwise healthy
19	24		organs or tissue, the introduction of implants or performance of
20	25		other plastic surgery, hormone treatment, or the use of drugs,
21	26		counseling, or therapy, for the purpose of furthering or assisting
22	27		the individual's identification as a member of the opposite
23	28		biological sex or group or demographic category that does not
24	29		correspond to the individual's biological sex.
25	30		(2) "Gender transition procedure or treatment" means a
26	31		medical procedure or treatment performed or provided for the
27	32		purpose of assisting an individual with a gender transition.
28	33		Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This
29	34		chapter applies only to a health benefit plan that provides
30	35		benefits for medical or surgical expenses or pharmacy benefits
31	36		incurred as a result of a health condition, accident, or sickness,
32	37		including an individual, group, blanket, or franchise insurance
33	38		policy or insurance agreement, a group hospital service contract,
34	39		or an individual or group evidence of coverage or similar coverage
35	40		document that is issued by:
36	41		(1) an insurance company;
37	42		(2) a group hospital service corporation operating
38	43		under Chapter 842;
39	44		(3) a health maintenance organization operating under
40	45		Chapter 843;
41	46		(4) an approved nonprofit health corporation that
42	47		holds a certificate of authority under Chapter 844;
43	48		(5) a multiple employer welfare arrangement that holds
44	49		a certificate of authority under Chapter 846;
45	50		(6) a stipulated premium company operating under
46	51		Chapter 884;
47	52		(7) a fraternal benefit society operating under
48	53		Chapter 885;
49	54		(8) a Lloyd's plan operating under Chapter 941; or
50	55		(9) an exchange operating under Chapter 942.
51	56		(b) Notwithstanding any other law, this chapter applies to:
52	57		(1) a small employer health benefit plan subject to
53	58		Chapter 1501, including coverage provided through a health group
54	59		cooperative under Subchapter B of that chapter;
55	60		(2) a standard health benefit plan issued under
56	61		Chapter 1507;
57	62		(3) a basic coverage plan under Chapter 1551;
58	63		(4) a basic plan under Chapter 1575;
59	64		(5) a primary care coverage plan under Chapter 1579;
60	65		(6) a plan providing basic coverage under Chapter
61	66		1601;
62	67		(7) nonprofit agricultural organization health
63	68		benefits offered by a nonprofit agricultural organization under
64	69		Chapter 1682;
65	70		(8) alternative health benefit coverage offered by a
66	71		subsidiary of the Texas Mutual Insurance Company under Subchapter
67	72		M, Chapter 2054;
68	73		(9) group health coverage made available by a school
69	74		district in accordance with Section 22.004, Education Code;
70	75		(10) the state Medicaid program, including the
71	76		Medicaid managed care program operated under Chapter 540,
72	77		Government Code;
73	78		(11) the child health plan program under Chapter 62,
74	79		Health and Safety Code;
75	80		(12) a regional or local health care program operated
76	81		under Section 75.104, Health and Safety Code;
77	82		(13) a self-funded health benefit plan sponsored by a
78	83		professional employer organization under Chapter 91, Labor Code;
79	84		(14) county employee group health benefits provided
80	85		under Chapter 157, Local Government Code; and
81	86		(15) health and accident coverage provided by a risk
82	87		pool created under Chapter 172, Local Government Code.
83	88		(c) This chapter applies to coverage under a group health
84	89		benefit plan provided to a resident of this state regardless of
85	90		whether the group policy, agreement, or contract is delivered,
86	91		issued for delivery, or renewed in this state.
87	92		(d) This chapter does not apply to a self-funded health
88	93		benefit plan as defined by the Employee Retirement Income Security
89	94		Act of 1974 (29 U.S.C. Section 1001 et seq.).
90	95		Sec. 1373.003. REQUIRED COVERAGE. (a) A health benefit
91	96		plan that provides or has ever provided coverage for an enrollee's
92	97		gender transition procedure or treatment shall provide coverage
93	98		for, including for any applicable diagnostic or billing code:
94	99		(1) all possible adverse consequences related to the
95	100		enrollee's gender transition procedure or treatment, including any
96	101		short- or long-term side effects of the procedure or treatment;
97	102		(2) any baseline and follow-up testing or screening
98	103		necessary to monitor the mental and physical health of the enrollee
99	104		on at least an annual basis without regard to the sex or gender
100	105		identity designation in the enrollee's medical record; and
101	106		(3) any procedure, treatment, or therapy necessary to
102	107		manage, reverse, reconstruct from, or recover from the enrollee's
103	108		gender transition procedure or treatment.
104	109		(b) A health benefit plan that offers coverage for a gender
105	110		transition procedure or treatment shall also provide the coverage
106	111		described by Subsection (a) to any enrollee who has undergone a
107	112		gender transition procedure or treatment regardless of whether the
108	113		enrollee was enrolled in the plan at the time of the procedure or
109	114		treatment.
110	115		SECTION 2. If before implementing any provision of this Act
111	116		a state agency determines that a waiver or authorization from a
112	117		federal agency is necessary for implementation of that provision,
113	118		the agency affected by the provision shall request the waiver or
114	119		authorization and may delay implementing that provision until the
115	120		waiver or authorization is granted.
116	121		SECTION 3. Section 1373.003, Insurance Code, as added by
117	122		this Act, applies only to a health benefit plan that is delivered,
118	123		issued for delivery, or renewed on or after January 1, 2026.
119	124		SECTION 4. This Act takes effect September 1, 2025.
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