HB3814 - Relating to health benefit plan coverage for perimenopause and menopause medications.

  89R14910 SCF-D     By: Pierson H.B. No. 3814       A BILL TO BE ENTITLED   AN ACT   relating to health benefit plan coverage for perimenopause and   menopause medications.          BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF TEXAS:          SECTION 1.  Chapter 1369, Insurance Code, is amended by   adding Subchapter O to read as follows:   SUBCHAPTER O. COVERAGE OF PERIMENOPAUSE AND MENOPAUSE MEDICATIONS           Sec.   1369.751.     APPLICABILITY OF SUBCHAPTER. (a) This   subchapter applies only to a health benefit plan that provides   benefits for medical, surgical, or prescription drug 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 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 subchapter 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;                 (4)     a plan providing basic coverage under Chapter   1601; and                 (5)     the state Medicaid program, including the Medicaid   managed care program operated under Chapter 540, Government Code.           Sec.   1369.752.     COVERAGE REQUIRED FOR PERIMENOPAUSE OR   MENOPAUSE MEDICATIONS. A health benefit plan that provides   prescription drug benefits must provide coverage for a prescription   drug to treat perimenopause or menopause.          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.  The changes in law made by this Act apply only to   a health benefit plan delivered, issued for delivery, or renewed on   or after January 1, 2026.          SECTION 4.  This Act takes effect September 1, 2025.