By: Hughes, Hall, Sparks S.B. No. 1257
A BILL TO BE ENTITLED
AN ACT
relating to required health benefit plan coverage for gender
transition adverse effects and reversals.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:
SECTION 1. Subtitle E, Title 8, Insurance Code, is amended
by adding Chapter 1373 to read as follows:
CHAPTER 1373. REQUIRED COVERAGE OF GENDER TRANSITION ADVERSE
EFFECTS AND REVERSALS
Sec. 1373.001. DEFINITIONS. In this chapter:
(1) "Gender transition" means a medical process by
which an individual's anatomy, physiology, or mental state is
treated or altered, including by the removal of otherwise healthy
organs or tissue, the introduction of implants or performance of
other plastic surgery, hormone treatment, or the use of drugs,
counseling, or therapy, for the purpose of furthering or assisting
the individual's identification as a member of the opposite
biological sex or group or demographic category that does not
correspond to the individual's biological sex.
(2) "Gender transition procedure or treatment" means a
medical procedure or treatment performed or provided for the
purpose of assisting an individual with a gender transition.
Sec. 1373.002. APPLICABILITY OF CHAPTER. (a) This
chapter applies only to a health benefit plan that provides
benefits for medical or surgical expenses or pharmacy benefits
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 chapter applies to:
(1) a small employer health benefit plan subject to
Chapter 1501, including coverage provided through a health group
cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under
Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter
1601;
(7) nonprofit agricultural organization health
benefits offered by a nonprofit agricultural organization under
Chapter 1682;
(8) alternative health benefit coverage offered by a
subsidiary of the Texas Mutual Insurance Company under Subchapter
M, Chapter 2054;
(9) group health coverage made available by a school
district in accordance with Section 22.004, Education Code;
(10) the state Medicaid program, including the
Medicaid managed care program operated under Chapter 540,
Government Code;
(11) the child health plan program under Chapter 62,
Health and Safety Code;
(12) a regional or local health care program operated
under Section 75.104, Health and Safety Code;
(13) a self-funded health benefit plan sponsored by a
professional employer organization under Chapter 91, Labor Code;
(14) county employee group health benefits provided
under Chapter 157, Local Government Code; and
(15) health and accident coverage provided by a risk
pool created under Chapter 172, Local Government Code.
(c) This chapter applies to coverage under a group health
benefit plan provided to a resident of this state regardless of
whether the group policy, agreement, or contract is delivered,
issued for delivery, or renewed in this state.
(d) This chapter does not apply to a self-funded health
benefit plan as defined by the Employee Retirement Income Security
Act of 1974 (29 U.S.C. Section 1001 et seq.).
Sec. 1373.003. REQUIRED COVERAGE. (a) A health benefit
plan that provides or has ever provided coverage for an enrollee's
gender transition procedure or treatment shall provide coverage
for, including for any applicable diagnostic or billing code:
(1) all possible adverse consequences related to the
enrollee's gender transition procedure or treatment, including any
short- or long-term side effects of the procedure or treatment;
(2) any baseline and follow-up testing or screening
necessary to monitor the mental and physical health of the enrollee
on at least an annual basis without regard to the sex or gender
identity designation in the enrollee's medical record; and
(3) any procedure, treatment, or therapy necessary to
manage, reverse, reconstruct from, or recover from the enrollee's
gender transition procedure or treatment.
(b) A health benefit plan that offers coverage for a gender
transition procedure or treatment shall also provide the coverage
described by Subsection (a) to any enrollee who has undergone a
gender transition procedure or treatment regardless of whether the
enrollee was enrolled in the plan at the time of the procedure or
treatment.
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. Section 1373.003, Insurance Code, as added by
this Act, applies only to a health benefit plan that is delivered,
issued for delivery, or renewed on or after January 1, 2026.
SECTION 4. This Act takes effect September 1, 2025.