By: Taylor of Galveston, Hall	S.B. No. 575
	(In the Senate - Filed February 13, 2015; February 23, 2015,
	read first time and referred to Committee on State Affairs;
	April 29, 2015, reported adversely, with favorable Committee
	Substitute by the following vote:  Yeas 7, Nays 1; April 29, 2015,
	sent to printer.)
Click here to see the committee vote
	COMMITTEE SUBSTITUTE FOR S.B. No. 575	By:  Schwertner

	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 L to read as follows:
	SUBTITLE L.  FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT
	CHAPTER 1691.  LEGISLATIVE CONSIDERATIONS
	Sec. 1691.001.  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 1692.  COVERAGE FOR ABORTION; PROHIBITIONS AND REQUIREMENTS
	Sec. 1692.001.  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. 1692.002.  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; and
	(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, 2016. 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, 2016, 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, 2015.
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