Bill Text: TX HB1113 | 2017-2018 | 85th Legislature | Introduced
Bill Title: Relating to health plan and health benefit plan coverage for abortions.
Spectrum: Partisan Bill (Republican 47-0)
Status: (Introduced - Dead) 2017-05-03 - Left pending in committee [HB1113 Detail]
Download: Texas-2017-HB1113-Introduced.html
85R2504 SCL-F | ||
By: Smithee | H.B. No. 1113 |
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relating to health plan and health benefit plan coverage for | ||
abortions. | ||
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS: | ||
SECTION 1. Title 8, Insurance Code, is amended by adding | ||
Subtitle M to read as follows: | ||
SUBTITLE M. FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT | ||
CHAPTER 1695. LEGISLATIVE CONSIDERATIONS | ||
Sec. 1695.001. CONSTITUTIONALITY OF PATIENT PROTECTION AND | ||
AFFORDABLE CARE ACT. This subtitle does not constitute an | ||
acknowledgment by the legislature of the legitimacy of the Patient | ||
Protection and Affordable Care Act (Pub. L. No. 111-148) as a | ||
constitutional exercise of the power of the United States Congress. | ||
CHAPTER 1696. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS | ||
Sec. 1696.001. DEFINITIONS. In this chapter: | ||
(1) "Abortion" and "medical emergency" have the | ||
meanings assigned by Section 171.002, Health and Safety Code. | ||
(2) "Health benefit exchange" means an American Health | ||
Benefit Exchange administered by the federal government or created | ||
under Section 1311(b) of the Patient Protection and Affordable Care | ||
Act (42 U.S.C. Section 18031(b)). | ||
(3) "Qualified health plan" has the meaning assigned | ||
by Section 1301(a) of the Patient Protection and Affordable Care | ||
Act (42 U.S.C. Section 18021(a)). | ||
Sec. 1696.002. PROHIBITED COVERAGE THROUGH HEALTH BENEFIT | ||
EXCHANGE. (a) A qualified health plan offered through a health | ||
benefit exchange may not provide coverage for an abortion other | ||
than coverage for an abortion performed due to a medical emergency. | ||
(b) Subsection (a) does not authorize coverage for an | ||
abortion based on a potential future medical condition that may | ||
result from a voluntary act of the woman or minor. | ||
(c) This section does not prevent a person from purchasing | ||
optional or supplemental coverage for abortions under a health | ||
benefit plan other than a qualified health plan offered through a | ||
health benefit exchange. | ||
SECTION 2. Subtitle A, Title 8, Insurance Code, is amended | ||
by adding Chapter 1218 to read as follows: | ||
CHAPTER 1218. COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS | ||
Sec. 1218.001. DEFINITIONS. In this chapter, "abortion" | ||
and "medical emergency" have the meanings assigned by Section | ||
171.002, Health and Safety Code. | ||
Sec. 1218.002. APPLICABILITY OF CHAPTER. (a) This chapter | ||
applies only to a health benefit plan that provides benefits for | ||
medical or surgical 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 offered by: | ||
(1) an insurance company; | ||
(2) a group hospital service corporation operating | ||
under Chapter 842; | ||
(3) a fraternal benefit society operating under | ||
Chapter 885; | ||
(4) a stipulated premium company operating under | ||
Chapter 884; | ||
(5) an exchange operating under Chapter 942; | ||
(6) a health maintenance organization operating under | ||
Chapter 843; | ||
(7) a multiple employer welfare arrangement that holds | ||
a certificate of authority under Chapter 846; or | ||
(8) an approved nonprofit health corporation that | ||
holds a certificate of authority under Chapter 844. | ||
(b) This chapter applies to group health coverage made | ||
available by a school district in accordance with Section 22.004, | ||
Education Code. | ||
(c) Notwithstanding any provision in Chapter 1551, 1575, | ||
1579, or 1601 or any other law, this chapter 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; | ||
and | ||
(4) basic coverage under Chapter 1601. | ||
(d) Notwithstanding Section 1501.251 or any other law, this | ||
chapter applies to coverage under a small or large employer health | ||
benefit plan subject to Chapter 1501. | ||
(e) Notwithstanding Section 1507.003 or 1507.053, this | ||
chapter applies to a standard health benefit plan provided under | ||
Chapter 1507. | ||
Sec. 1218.003. COVERAGE BY HEALTH BENEFIT PLAN. (a) A | ||
health benefit plan may provide coverage for abortion only if: | ||
(1) the coverage is provided to an enrollee separately | ||
from other health benefit plan coverage offered by the health | ||
benefit plan issuer; | ||
(2) an enrollee pays separately from, and in addition | ||
to, the premium for other health benefit plan coverage a premium for | ||
coverage for abortion; | ||
(3) an enrollee provides a signature for coverage for | ||
abortion, separately and distinct from the signature required for | ||
other health benefit plan coverage offered by the health benefit | ||
plan issuer; or | ||
(4) the coverage provides benefits only for an | ||
abortion performed due to a medical emergency. | ||
(b) Subsection (a)(4) does not authorize coverage for an | ||
abortion based on a potential future medical condition that may | ||
result from a voluntary act of the enrollee. | ||
Sec. 1218.004. CALCULATION OF PREMIUM. (a) A health | ||
benefit plan issuer that provides coverage for abortion shall | ||
calculate the premium for the coverage so that the premium fully | ||
covers the estimated cost of abortion per enrollee, determined on | ||
an average actuarial basis. | ||
(b) In calculating a premium under Subsection (a), the | ||
health benefit plan issuer may not take into account any cost | ||
savings in other health benefit plan coverage offered by the health | ||
benefit plan issuer that is estimated to result from coverage for | ||
abortion, including costs associated with prenatal care, delivery, | ||
or postnatal care. | ||
(c) A health benefit plan issuer that provides coverage | ||
other than coverage for abortion may not provide a premium discount | ||
to or reduce the premium for an enrollee for coverage other than | ||
coverage for abortion on the basis that the enrollee has health | ||
benefit plan coverage for abortion. | ||
Sec. 1218.005. NOTICE BY ISSUER. A health benefit plan | ||
issuer that provides coverage for abortion shall at the time of | ||
enrollment in the health benefit plan provide each enrollee with a | ||
notice that: | ||
(1) coverage for abortion is optional and separate | ||
from other health benefit plan coverage offered by the health | ||
benefit plan issuer; | ||
(2) the premium cost for coverage for abortion is a | ||
premium paid separately from, and in addition to, the premium for | ||
other health benefit plan coverage offered by the health benefit | ||
plan issuer; and | ||
(3) the enrollee may enroll in a health benefit plan | ||
that provides coverage other than coverage for abortion without | ||
obtaining coverage for abortion. | ||
Sec. 1218.006. ACCEPTANCE OR REJECTION OF SUPPLEMENTAL | ||
COVERAGE BY EMPLOYEES AND GROUP MEMBERS. If a small or large | ||
employer health benefit plan or group health benefit plan offers | ||
coverage for abortion, the employer offering the employer health | ||
benefit plan or the entity offering the group health benefit plan | ||
shall provide each employee or group member with an opportunity to | ||
accept or reject supplemental coverage for abortion: | ||
(1) at the beginning of employment or when the group | ||
member's coverage begins, as applicable; and | ||
(2) at least one time in each calendar year after the | ||
first year of employment or group coverage. | ||
SECTION 3. This Act applies only to a qualified health plan | ||
offered through a health benefit exchange or a health benefit plan | ||
that is delivered, issued for delivery, or renewed on or after | ||
January 1, 2018. A qualified health plan offered through a health | ||
benefit exchange or a health benefit plan that is delivered, issued | ||
for delivery, or renewed before January 1, 2018, is governed by the | ||
law as it existed immediately before the effective date of this Act, | ||
and that law is continued in effect for that purpose. | ||
SECTION 4. This Act takes effect September 1, 2017. |