85R2504 SCL-F     By: Smithee H.B. No. 1113       A BILL TO BE ENTITLED   AN ACT   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.