SB 189 — REPRODUCTIVE HEALTH CARE COVERAGE

e t 17 (3) prior authorization or step therapy w l n d 18 requirements;

[or] = = 19 (4) quantity or fill limits if the practice a l i a e r 20 would result in an insured person receiving less than a ea t 17m m 21 twelve-months' duration of contraception dispensed either at wd lr ne d22 18 one time or, if requested by the insured person at the point of =c =e 19s ak l23 dispensing, over a twelve-month period;

or ie a en rb 2024 [(4)] (5) any other restrictions or delays on au t[ m m 21 the coverage.

d.233817.3 r- e6 22- STBTC/SB 189 C.

A group health plan may discourage brand-name c e s k 23 pharmacy drugs or items by applying cost sharing to brand-name e a n b 24 drugs or items when at least one generic or therapeutic u [ equivalent is covered within the same method of contraception .232279.2 - 6 - without patient cost sharing;

The process for requesting an expedited hearing pursuant to e t 17 this subsection shall:

w l n d 18 (1) be easily accessible, transparent, = = 19 sufficiently expedient and not unduly burdensome on an a l i a e r 20 enrollee, the enrollee's representative or the enrollee's ea t 17m m 21 health care provider;

wd lr ne d22 18 (2) defer to the determination of the =c =e 19s ak l23 enrollee's health care provider;

and ie a en rb 2024 (3) provide for a determination of the claim au t[ m m 21 according to a time frame and in a manner that takes into d.233817.3 r- e7 22- STBTC/SB 189 account the nature of the claim and the medical exigencies c e s k 23 involved for a claim involving an urgent health care need.

e a n b 24 E.

A group health plan shall not require a u [ prescription for any drug, item or service that is available .232279.2 - 7 - without a prescription.

or (2) permit a group health plan to limit e t 17 coverage or impose cost sharing for an alternate method of w l n d 18 contraception if an enrollee changes contraceptive methods = = 19 before exhausting a previously dispensed supply.

a l i a e r 20 H.

The provisions of this section shall not apply ea t 17m m 21 to:

wd lr ne d22 18 (1) a high-deductible health benefit plan =c =e 19s ak l23 issued or renewed in this state until an eligible insured's ie a en rb 2024 deductible has been met;

or au t[ m m 21 (2) a short-term travel, an accident-only, a d.233817.3 r- e8 22- STBTC/SB 189 hospital-indemnity-only, a limited-benefit or a disease- c e s k 23 specific group health [plans] plan.

e a n b 24 I.

u [ (1) "contraceptive method categories .232279.2 - 8 - identified by the federal food and drug administration":

and e t 17 (b) does not mean a product that has w l n d 18 been recalled for safety reasons or withdrawn from the market;

= = 19 (2) "cost sharing" means a deductible, a l i a e r 20 copayment or coinsurance that an enrollee is required to pay in ea t 17m m 21 accordance with the terms of a group health plan;

and wd lr ne d22 18 (3) "health care provider" means an individual =c =e 19s ak l23 licensed to provide health care in the ordinary course of ie a en rb 2024 business." au t[ m m 21 SECTION 6.

Section 27-2-12.29 NMSA 1978 (being Laws 2019, d.233817.3 r- e9 22- STBTC/SB 189 Chapter 263, Section 2) is amended to read:

c e s k 23 "27-2-12.29.

MEDICAL ASSISTANCE--REIMBURSEMENT FOR A ONE- e a n b 24 YEAR SUPPLY OF COVERED PRESCRIPTION CONTRACEPTIVE DRUGS OR u [ DEVICES.-- .232279.2 - 9 - A.

(2) require a health care provider to e t 17 prescribe twelve months of contraceptives at one time;

or w l n d 18 (3) permit the authority or a managed care = = 19 organization to:

a l i a e r 20 (a) impose restrictions or delays on ea t 17m m 21 coverage, including quantity or fill limits, if the practice wd lr ne d22 18 would result in a recipient receiving less than a twelve- =c =e 19s ak l23 months' duration of contraception dispensed either at one time ie a en rb 2024 or, if requested by the recipient at the point of dispensing, au t[ m m 21 over a twelve-month period;

d.233817.3 r- e10 22- STBTC/SB 189 (b) limit coverage or impose cost c e s k 23 sharing for an alternative method of contraception if a e a n b 24 recipient changes contraceptive methods before exhausting a u [ previously dispensed supply of contraceptives;

.232279.2 - 10 - (c) limit the quantity of contraceptive drugs or devices dispensed;

e t 17 vaginal ring;

sponge with w l n d 18 spermicide;

male and female = = 19 condoms;

levonorgestrel a l i a e r 20 emergency contraception;

and any other self-administered ea t 17m m 21 contraceptive method categories approved by the federal food wd lr ne d22 18 and drug administration." =c =e 19s ak l23 SECTION 7.

A new section of the Public Assistance Act is ie a en rb 2024 enacted to read:

au t[ m m 21 "[NEW MATERIAL] FAMILY PLANNING AND RELATED SERVICES.-- d.233817.3 r- e11 22- STBTC/SB 189 A.

When family planning services or family- c e s k 23 planning-related services are provided in accordance with the e a n b 24 Public Assistance Act, the authority shall authorize u [ reimbursement for services without quantity limitation, .232279.2 - 11 - utilization controls or prior authorization.

When abortion care services are provided in e t 17 accordance with the Public Assistance Act, the authority, an w l n d 18 intermediary or a managed care organization shall reimburse the = = 19 provider of those services as distinct, non-bundled procedural a l i a e r 20 services and shall allow modifier codes, including increased ea t 17m m 21 professional service, distinct procedural services and separate wd lr ne d22 18 structures, to reflect the increased time and training required =c =e 19s ak l23 when applicable.

ie a en rb 2024 D.

au t[ m m 21 (1) "family planning services" means services d.233817.3 r- e12 22- STBTC/SB 189 covered by the federal Title X family planning program, c e s k 23 regardless of an individual's or a partner's age, sex or gender e a n b 24 identity;

and u [ (2) "family-planning-related services" means .232279.2 - 12 - a medical diagnosis, treatment or preventive service that is routinely provided pursuant to a family planning visit, including:

(e) prevention, diagnosis or treatment of a sexually transmitted infection or sexually transmitted e t 17 disease;

and w l n d 18 (f) mental health screening and = = 19 referral." a l i a e r 20 SECTION 8.

A new section of the Public Assistance Act is ea t 17m m 21 enacted to read:

wd lr ne d22 18 "[NEW MATERIAL] LACTATIONEXCLUSIVE SUPPORT.--STATE =FUNDING =FOR 19CERTAIN c e s k 23 ENTITIES.-- e a ln b 24 A.

The authorityauthority, shalla ensuremanaged thatcare medicalorganization ior au e[ rany 20other assistanceintermediary coverage,responsible includingfor coveragereimbursing providedhealth bycare a.233817.3 managed- 13 - STBTC/SB 189 providers under the state's medicaid program shall reimburse a tprohibited mentity, mas 21defined carein organization,Section provides71113 coverageof forPublic lactationLaw support,119-21, dfor rservices eprovided 22using including:only state funds.

c e s k 23 (1) prior to delivery, single-user lactation e a n b 24 supplies and equipment;

and u [ (2) comprehensive lactation support services .232279.2 - 13 - provided by a lactation care provider licensed pursuant to the Lactation Care Provider Act.

AccessThe requirements of this section do not apply to multi-userservices loanedprovided breastby pumpsa shallprohibited beentity prioritizedthat is eligible for personsreimbursement withfrom premature,the medicallyfederal fragile,centers lowfor birthmedicare weightand infantsmedicaid orservices withat lactationthe complications.time the services are provided.

AccessC. to multi-user loaned breast pumps shall be authorized by a health care provider." SECTION 9.

As used in this section, "state's medicaid program" means the state program acting to leverage federal benefits for state residents pursuant to Title 19 or Title 20 of the federal Social Security Act." SECTION 9.

"[NEW MATERIAL] GENDER-AFFIRMINGLACTATION CARE.--SUPPORT.-- A.

The authority shall ensure that medical assistance coverage, including coverage provided by anya managed e t 17 care organizations,organization, provides coverage for gender-affirminglactation care.support, w l n d 18 including:

= = 19 (1) prior to delivery, single-user lactation a l i a e r 20 supplies and equipment;

and a t m m 21 (2) comprehensive lactation support services d r e 22 provided by a lactation care provider licensed pursuant to the c e s k 23 Lactation Care Provider Act.

e a n b 24 B.

Access to multi-user loaned breast pumps shall u [ be prioritized for persons with premature, medically fragile, .233817.3 - 14 - STBTC/SB 189 low birth weight infants or with lactation complications.

Access to multi-user loaned breast pumps shall be authorized by a health care provider." SECTION 10.

A new section of the Public Assistance Act is enacted to read:

"[NEW MATERIAL] GENDER-AFFIRMING HEALTH CARE.-- A.

The authority shall ensure that medical assistance coverage, including coverage provided by any managed care organizations, provides coverage for gender-affirming health care.

(1) may be subject to other general exclusions e t 17 and limitations of medical assistance coverage, including w l n d 18 coordination of benefits, participating provider requirements = = 19 a l and restrictions on services provided by family or household i a e r 20 members;

and ae t m17 m 21 (2) shall not be subject to cost-sharing dw rl en 22d 18 provisions.

c= e= s19 k 23 C.

ea l i a ne br 2420 (1) "cost sharing" means a deductible, ua [t m m 21 copayment or coinsurance that a recipient is required to pay in .232279.2d -r 14e -22 accordance with the terms of a health care coverage plan;

and (2)c "gender-affirminge care"s meansk a23 procedure,(2) service,"gender-affirming drug,health devicecare" ormeans producte that a physicaln orb behavioral24 healthpsychological, carebehavioral, providersurgical, prescribespharmaceutical toand treatmedical anu individual[ forcare, incongruenceservices betweenand thesupplies individual'sprovided genderto identitysupport anda theperson's individual's.233817.3 sex- assignment15 at- birth."STBTC/SB 189 gender identity." SECTION 10.11.

e t 17 (1) a high-deductible health benefit plan w l n d 18 issued or renewed in this state until an eligible insured's = = 19 a l deductible has been met;

or i a e r 20 (2) a short-term travel, an accident-only, a a t m m 21 hospital-indemnity-only, a limited-benefit or a specified- d r e 22t 17 disease health care plan.

cw el sn kd 2318 C.

As used in this section, "cost sharing" means a e= a= n19 b 24 deductible, copayment or coinsurance that an enrollee is ua [l i a e r 20 required to pay in accordance with the terms of an individual .232279.2a -t 15m -m 21 or a group health insurance policy, health care plan or d r e 22 certificate of insurance." c e s k 23 SECTION 11.12.

Section 59A-22-42 NMSA 1978 (being Laws e a n b 24 2001, Chapter 14, Section 1, as amended) is amended to read:

u [ "59A-22-42.

COVERAGE FOR PRESCRIPTION CONTRACEPTIVE .233817.3 - 16 - STBTC/SB 189 DRUGS OR DEVICES.-- A.

(2) a sufficient number and assortment of oral contraceptive pills to reflect the variety of oral e t 17 contraceptives approved by the federal food and drug w l n d 18 administration;

[and] = = 19 a l (3) clinical services related to the provision i a e r 20 or use of contraception, including consultations, examinations, a t m m 21 procedures, ultrasound, anesthesia, patient education, d r e 22t 17 counseling, device insertion and removal, follow-up care and cw el sn kd 2318 side-effects management;

e= a= n19 b 24 (4) a sufficient quantity to allow for the ua [l i a e r 20 continuous use of clinically appropriate contraception as .232279.2a -t 16m -m 21 determined by the prescribing provider;

and d r e 22 (5) United States food and drug c e s k 23 administration-approved, -cleared or -granted over-the-counter e a n b 24 contraception, including point-of-sale coverage for over-the- u [ counter contraception at in-network dispensing entities.

.233817.3 - 17 - STBTC/SB 189 B.

[or] (4) quantity or fill limits if the practice would result in an insured receiving less than a twelve-months' duration of contraception dispensed either at one time or, if requested by the insured at the point of dispensing, over a e t 17 twelve-month period;

or w l n d 18 [(4)] (5) any other restrictions or delays on = = 19 a l the coverage.

i a e r 20 C.

An insurer may discourage brand-name pharmacy a t m m 21 drugs or items by applying cost sharing to brand-name drugs or d r e 22t 17 items when at least one generic or therapeutic equivalent is cw el sn kd 2318 covered within the same method of contraception without patient e= a= n19 b 24 cost sharing;

provided that when an insured's health care ua [l i a e r 20 provider determines that a particular drug or item is medically .232279.2a -t 17m -m 21 necessary, the individual or group health insurance policy, d r e 22 health care plan or certificate of insurance shall cover the c e s k 23 brand-name pharmacy drug or item without cost sharing.

Medical e a n b 24 necessity may include considerations such as severity of side u [ effects, differences in permanence or reversibility of .233817.3 - 18 - STBTC/SB 189 contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider.

(2) defer to the determination of the e t 17 insured's health care provider;

and w l n d 18 (3) provide for a determination of the claim = = 19 a l according to a time frame and in a manner that takes into i a e r 20 account the nature of the claim and the medical exigencies a t m m 21 involved for a claim involving an urgent health care need.

d r e 22t 17 E.

An insurer shall not require a prescription for cw el sn kd 2318 any drug, item or service that is available without a e= a= n19 b 24 prescription.

ua [l i a e r 20 F.

An insurer shall provide coverage and shall .232279.2a -t 18m -m 21 reimburse a health care provider or dispensing entity on a per- d r e 22 unit basis for dispensing [a six-month supply of c e s k 23 contraceptives] contraception intended to last the insured for e a n b 24 a duration of twelve months, as permitted by the covered u [ person's prescription, dispensed at one time;

provided that the .233817.3 - 19 - STBTC/SB 189 contraceptives are prescribed and self-administered.

or (b) limit the quantity of contraceptives e t 17 dispensed based on the number of months left in the plan year;

w l n d 18 or = = 19 a l (3) permit an insurer or a pharmacy benefits i a e r 20 manager to deny coverage for the continuous use of clinically a t m m 21 appropriate contraception as determined by the prescribing d r e 22t 17 provider.

cw el sn kd 2318 H.

A religious entity purchasing individual or e= a= n19 b 24 group health insurance coverage may elect to exclude ua [l i a e r 20 prescription contraceptive drugs or devices from the health .232279.2a -t 19m -m 21 coverage purchased.

d r e 22 [H.] I.

The provisions of this section shall not c e s k 23 apply to:

e a n b 24 (1) a high-deductible health benefit plan u [ issued or renewed in this state until an eligible insured's .233817.3 - 20 - STBTC/SB 189 deductible has been met;

e t 17 (a) means tubal ligation;

sterilization w l n d 18 implant;

intrauterine device with = = 19 a l progestin;

i a e r 20 combined oral contraceptives;

extended or continuous use oral a t m m 21 contraceptives;

d r e 22t 17 vaginal ring;

sponge with cw el sn kd 2318 spermicide;

male and female e= a= n19 b 24 condoms;

ua [l i a e r 20 levonorgestrel emergency contraception;

and any additional .232279.2a -t 20m -m 21 contraceptive method categories approved by the federal food d r e 22 and drug administration;

and c e s k 23 (b) does not mean a product that has e a n b 24 been recalled for safety reasons or withdrawn from the market;

u [ (2) "cost sharing" means a deductible, .233817.3 - 21 - STBTC/SB 189 copayment or coinsurance that an insured is required to pay in accordance with the terms of an individual or group health insurance policy, health care plan or certificate of insurance;

A religious entity purchasing individual or group health insurance coverage may elect to exclude prescription contraceptive drugs or devices from the health coverage purchased.]" e t 17 SECTION 12.13.

A new section of Chapter 59A, Article 22 w l n d 18 NMSA 1978 is enacted to read:

= = 19 a l "[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.-- i a e r 20 A.

An individual or group health insurance policy, a t m m 21 health care plan or certificate of health insurance that is d r e 22 delivered, issued for delivery or renewed in this state shall c e s k 23 establish a special enrollment period to provide coverage to an e a n b 24 uninsured person if the person is eligible to be insured and u [ provides a certification from a health care provider to the .232279.2 - 21 - insurer that the person is pregnant.

B.

Coverage shall be effective before the end of the first month in which the person receives certification of the pregnancy, unless the person elects to have coverage effective on the first day of the month following the date that the person makes a plan selection." SECTION 13.

"[NEW MATERIAL] COVERAGESPECIAL FORENROLLMENT GENDER-AFFIRMINGPERIOD--PREGNANCY.-- CARE.-- A.

An individual or group health insurance policy, health care plan or certificate of health insurance that is e t 17 delivered, issued for delivery or renewed in this state shall w l n d 18 establish a special enrollment period to provide coverage forto an = = 19 uninsured person if the totalperson costis ofeligible gender-affirmingto care.be insured and a l i a e r 20 provides a certification from a health care provider to the a t m m 21 insurer that the person is pregnant.

d r e 22 B.

Coverage shall be effective before the end of c e s k 23 the first month in which the person receives certification of e a n b 24 the pregnancy, unless the person elects to have coverage u [ effective on the first day of the month following the date that .233817.3 - 22 - STBTC/SB 189 the person makes a plan selection." SECTION 14.

A new section of Chapter 59A, Article 22 NMSA 1978 is enacted to read:

"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING HEALTH CARE.-- A.

An individual or group health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for the total cost of gender-affirming health care.

e t 17 (1) a high-deductible health benefit plan w l n d 18 issued or renewed in this state until an eligible insured's = = 19 a l deductible has been met;

or i a e rt 2017 (2) a short-term travel, an accident-only, a aw tl mn md 2118 hospital-indemnity-only, a limited-benefit or a specified- d= r= e19 22 disease health care plan.

ca el si ka 23e r 20 C.

e a nt bm 24m 21 (1) "cost sharing" means a deductible, ud [r e 22 copayment or coinsurance that an insured is required to pay in .232279.2c -e 22s -k 23 accordance with the terms of an individual or group health e a n b 24 insurance policy, health care plan or certificate of insurance;

andu (2)[ "gender-affirmingand care".233817.3 means- a23 procedure,- service,STBTC/SB drug,189 device(2) or"gender-affirming producthealth thatcare" ameans physicalpsychological, orbehavioral, behavioralsurgical, healthpharmaceutical careand providermedical prescribescare, toservices treatand ansupplies individualprovided forto incongruencesupport betweena theperson's individual's gender identityidentity." and the individual's sex assignment at birth." SECTION 14.15.

e t 17 B.

The provisions of this section shall not apply w l n d 18 to:

= = 19 a l (1) a high-deductible health benefit plan i a e r 20 issued or renewed in this state until an eligible insured's ae t m17 m 21 deductible has been met;

or dw rl en 22d 18 (2) a short-term travel, an accident-only, a c= e= s19 k 23 hospital-indemnity-only, a limited-benefit or a specified- ea l i a ne br 2420 disease health care plan.

ua [t m m 21 C.

As used in this section, "cost sharing" means a .232279.2d -r 23e -22 deductible, copayment or coinsurance that an insured is c e s k 23 required to pay in accordance with the terms of an individual e a n b 24 or a group health insurance policy, health care plan or u [ certificate of insurance." .233817.3 - 24 - STBTC/SB 189 SECTION 15.16.

(2) a sufficient number and assortment of oral e t 17 contraceptive pills to reflect the variety of oral w l n d 18 contraceptives approved by the federal food and drug = = 19 a l administration;

[and] i a e r 20 (3) clinical services related to the provision ae t m17 m 21 or use of contraception, including consultations, examinations, dw rl en 22d 18 procedures, ultrasound, anesthesia, patient education, c= e= s19 k 23 counseling, device insertion and removal, follow-up care and ea l i a ne br 2420 side-effects management;

ua [t m m 21 (4) a sufficient quantity to allow for the .232279.2d -r 24e -22 continuous use of clinically appropriate contraception as c e s k 23 determined by the prescribing provider;

and e a n b 24 (5) United States food and drug u [ administration-approved, -cleared or -granted over-the-counter .233817.3 - 25 - STBTC/SB 189 contraception, including point-of-sale coverage for over-the- counter contraception at in-network dispensing entities.

[or] (4) quantity or fill limits if the practice would result in a covered person receiving less than a twelve-months' duration of contraception dispensed either at e t 17 one time or, if requested by the insured at the point of w l n d 18 dispensing, over a twelve-month period;

or = = 19 a l [(4)] (5) any restrictions or delays on the i a e r 20 coverage.

ae t m17 m 21 C.

An insurer may discourage brand-name pharmacy dw rl en 22d 18 drugs or items by applying cost sharing to brand-name drugs or c= e= s19 k 23 items when at least one generic or therapeutic equivalent is ea l i a ne br 2420 covered within the same method category of contraception ua [t m m 21 without cost sharing by the insured;

provided that when an .232279.2d -r 25e -22 insured's health care provider determines that a particular c e s k 23 drug or item is medically necessary, the individual or group e a n b 24 health insurance policy, health care plan or certificate of u [ health insurance shall cover the brand-name pharmacy drug or .233817.3 - 26 - STBTC/SB 189 item without cost sharing.

(1) be easily accessible, transparent, sufficiently expedient and not unduly burdensome on an insured, the insured's representative or the insured's health care e t 17 provider;

w l n d 18 (2) defer to the determination of the = = 19 a l insured's health care provider;

and i a e r 20 (3) provide for a determination of the claim ae t m17 m 21 according to a time frame and in a manner that takes into dw rl en 22d 18 account the nature of the claim and the medical exigencies c= e= s19 k 23 involved for a claim involving an urgent health care need.

ea l i a ne br 2420 E.

An insurer shall not require a prescription for ua [t m m 21 any drug, item or service that is available without a .232279.2d -r 26e -22 prescription.

c e s k 23 F.

An individual or group health insurance policy, e a n b 24 health care plan or certificate of health insurance shall u [ provide coverage and shall reimburse a health care provider or .233817.3 - 27 - STBTC/SB 189 dispensing entity on a per unit basis for dispensing [a six- month supply of contraceptives] contraception intended to last the insured for a duration of twelve months, as permitted by the insured's prescription, dispensed at one time;

(a) limit coverage or impose cost sharing for an alternate method of contraception if an insured changes contraceptive methods before exhausting a previously e t 17 dispensed supply;

w l n d 18 (b) limit the quantity of contraceptives = = 19 a l dispensed based on the number of months left in the plan year;

ior a e r 20 or a t m17 m 21 (c) deny coverage for the continuous use dw rl en 22d 18 of clinically appropriate contraception as determined by the c= e= s19 k 23 prescribing provider.

ea l i a ne br 2420 H.

A religious entity purchasing individual or ua [t m m 21 group health insurance coverage may elect to exclude .232279.2d -r 27e -22 prescription contraceptive drugs or items from the health c e s k 23 insurance coverage purchased.

e a n b 24 [H.] I.

The provisions of this section shall not u [ apply to:

.233817.3 - 28 - STBTC/SB 189 (1) a high-deductible health benefit plan issued or renewed in this state until an eligible insured's deductible has been met;

(1) "contraceptive method categories e t 17 identified by the federal food and drug administration":

w l n d 18 (a) means tubal ligation;

sterilization = = 19 a l implant;

intrauterine device with i a e r 20 progestin;

ae t m17 m 21 combined oral contraceptives;

extended or continuous use oral dw rl en 22d 18 contraceptives;

c= e= s19 k 23 vaginal ring;

sponge with ea l i a ne br 2420 spermicide;

male and female ua [t m m 21 condoms;

.232279.2d -r 28e -22 levonorgestrel emergency contraception;

and any additional c e s k 23 contraceptive method categories approved by the federal food e a n b 24 and drug administration;

and u [ (b) does not mean a product that has .233817.3 - 29 - STBTC/SB 189 been recalled for safety reasons or withdrawn from the market;

A religious entity purchasing individual or group health insurance coverage may elect to exclude prescription contraceptive drugs or items from the health e t 17 insurance coverage purchased.]" w l n d 18 SECTION 16.17.

A new section of Chapter 59A, Article 23 = = 19 a l NMSA 1978 is enacted to read:

i a e r 20 "[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.-- a t m m 21 A.

A group or blanket health insurance policy, d r e 22 health care plan or certificate of health insurance that is c e s k 23 delivered, issued for delivery or renewed in this state shall e a n b 24 establish a special enrollment period to provide coverage to an u [ uninsured person if the person is eligible to be insured and .232279.2 - 29 - provides a certification from a health care provider to the insurer that the person is pregnant.

B.

Coverage shall be effective before the end of the first month in which the uninsured person receives certification of the pregnancy, unless the person elects to have coverage effective on the first day of the month following the date that the person makes a plan selection." SECTION 17.

"[NEW MATERIAL] COVERAGESPECIAL FORENROLLMENT GENDER-AFFIRMINGPERIOD--PREGNANCY.-- CARE.--e t 17 A.

A group or blanket health insurance policy, w l n d 18 health care plan or certificate of health insurance that is = = 19 delivered, issued for delivery or renewed in this state shall a l i a e r 20 establish a special enrollment period to provide coverage forto an a t m m 21 uninsured person if the totalperson costis ofeligible gender-affirmingto care.be insured and d r e 22 provides a certification from a health care provider to the c e s k 23 insurer that the person is pregnant.

e a n b 24 B.

Coverage shall be effective before the end of u [ the first month in which the uninsured person receives .233817.3 - 30 - STBTC/SB 189 certification of the pregnancy, unless the person elects to have coverage effective on the first day of the month following the date that the person makes a plan selection." SECTION 18.

A new section of Chapter 59A, Article 23 NMSA 1978 is enacted to read:

"[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING HEALTH CARE.-- A.

A group or blanket health insurance policy, health care plan or certificate of health insurance that is delivered, issued for delivery or renewed in this state shall provide coverage for the total cost of gender-affirming health care.

The provisions of this section shall not apply e t 17 to:

w l n d 18 (1) a high-deductible health benefit plan =e =t 1917 a l issued or renewed in this state until an eligible insured's iw al en rd 2018 deductible has been met;

or a= t= m19 m 21 (2) a short-term travel, an accident-only, a da rl i a e 22r 20 hospital-indemnity-only, a limited-benefit or a specified- ca et sm km 2321 disease health care plan.

ed ar ne b22 24 C.

uc [e s k 23 (1) "cost sharing" means a deductible, .232279.2e -a 30n -b 24 copayment or coinsurance that an insured is required to pay in u [ accordance with the terms of an individual or a group health .233817.3 - 31 - STBTC/SB 189 insurance policy, health care plan or certificate of insurance;

and (2) "gender-affirming health care" means apsychological, procedure,behavioral, service,surgical, drug,pharmaceutical deviceand ormedical productcare, thatservices aand physicalsupplies orprovided behavioral health care provider prescribes to treatsupport ana individualperson's for incongruence between the individual's gender identityidentity." and the individual's sex assignment at birth." SECTION 18.19.

A new section of the New Mexico Health MaintenanceInsurance OrganizationExchange LawAct is enacted to read:

"[NEW MATERIAL] ABORTIONREPRODUCTIVE CARE--NOHEALTH COSTCARE SHARING.--ACCESS A.FUND.--The "reproductive health care access fund" is created as a nonreverting fund in the state treasury.

The fund consists of distributions, appropriations, gifts, grants, donations, income from investment of the fund and any other revenue credited to the fund.

The health care authority shall administer the fund, and money in the fund is subject to appropriation by the legislature for the purpose of funding e t 17 programs and initiatives that provide access to affordable w l n d 18 reproductive health care.

Expenditures shall be by warrant of = = 19 the secretary of finance and administration pursuant to a l i a e r 20 vouchers signed by the secretary of health care authority or a t m m 21 the secretary's authorized representative." d r e 22 SECTION 20.

A new section of the New Mexico Health c e s k 23 Insurance Exchange Act is enacted to read:

e a n b 24 "[NEW MATERIAL] ABORTION SERVICES SEGREGATED ACCOUNT-- u [ REPORTING--SURCHARGE.-- .233817.3 - 32 - STBTC/SB 189 A.

A health insurance issuer offering a health benefit plan that covers abortion services through the exchange shall:

(1) no later than July 1, 2026, submit a report to the superintendent that details the amount of money present in a segregated account created pursuant to 42 U.S.C.

Section 18023;

and (2) by March 31, 2027 and each March 31 thereafter, report to the superintendent the receipts, disbursements, interest accrued and ending balance for a segregated account created pursuant to 42 U.S.C.

Section 18023.

The report shall document all money added to segregated accounts during the previous calendar year and shall include any related documentation required by the superintendent.

B.

Upon receipt of a report required pursuant to Subsection A of this section, the superintendent shall assess a e t 17 surcharge on each segregated account created pursuant to 42 w l n d 18 U.S.C.

Section 18023 in an amount equal to the segregated = = 19 account's balance to be paid on or before the twenty-fifth day a l i a e r 20 of the month following the month in which the surcharge is a t m m 21 assessed.

All money collected pursuant to the surcharge shall d r e 22 be deposited into the reproductive health care access fund." c e s k 23 SECTION 21.

A new section of the Health Maintenance e a n b 24 Organization Law is enacted to read:

u [ "[NEW MATERIAL] ABORTION CARE--NO COST SHARING.-- .233817.3 - 33 - STBTC/SB 189 A.

The coverage shall not be subject to cost- e t 17 sharing provisions.

w l n d 18 B.

The provisions of this section shall not apply = = 19 a l to:

i a e r 20 (1) a high-deductible health benefit plan a t m m 21 issued or renewed in this state until an eligible enrollee's d r e 22 deductible has been met;

or c e s k 23 (2) a short-term travel, an accident-only, a e a n b 24 hospital-indemnity-only, a limited-benefit or a specified- u [ disease health care plan.

.232279.2 - 31 - C.

As used in this section, "cost sharing" means a deductible, copayment or coinsurance that an enrollee is required to pay in accordance with the terms of a contract." SECTION 19.

Section 59A-46-44 NMSA 1978 (being Laws 2001, Chapter 14, Section 3, as amended) is amended to read:

"59A-46-44.

COVERAGE FOR CONTRACEPTION.-- A.

[Each] An individual [and] or group health maintenance organization contract delivered or issued for delivery in this state that provides a prescription drug benefit shall provide, at a minimum, the following coverage:

(1) at least one product or form of contraception in each of the contraceptive method categories identified by the federal food and drug administration;

(2) a sufficient number and assortment of oral contraceptive pills to reflect the variety of oral contraceptives approved by the federal food and drug e t 17 administration;

[and] w l n d 18 (3) clinical services related to the provision = = 19 a l or use of contraception, including consultations, examinations, i a e r 20 procedures, ultrasound, anesthesia, patient education, a t m m 21 counseling, device insertion and removal, follow-up care and d r e 22 side-effects management;

c e s k 23 (4) a sufficient quantity to allow for the e a n b 24 continuous use of clinically appropriate contraception as u [ determined by the prescribing provider;

and .232279.2 - 32 - (5) United States food and drug administration-approved, -cleared or -granted over-the-counter contraception, including point-of-sale coverage for over-the- counter contraception at in-network dispensing entities.

ExceptThe asprovisions provided in Subsection C of this section, the coverage required pursuant to this section shall not beapply subject to:

(1) enrolleea costhigh-deductible sharing;health benefit plan issued or renewed in this state until an eligible enrollee's deductible has been met;

or (2) utilizationa review;short-term travel, an accident-only, a hospital-indemnity-only, a limited-benefit or a specified- disease health care plan.

(3)C. prior authorization or step-therapy requirements;

[or]As (4)used quantity or fill limits if the practice would result in anthis enrolleesection, receiving"cost lesssharing" thanmeans a twelve-deductible, months'copayment durationor ofcoinsurance contraceptionthat dispensedan eitherenrollee atis onerequired timeto or,pay ifin requestedaccordance bywith the enrolleeterms atof thea pointcontract." ofe dispensing,t over17 aSECTION twelve-month22. period;

orSection e59A-46-44 tNMSA 171978 [(4)](being (5)Laws anyw otherl restrictionsn ord delays18 on2001, wChapter l14, nSection d3, 18as theamended) coverage.is amended to read:

= = 19 a"59A-46-44. l C.

ACOVERAGE healthFOR maintenanceCONTRACEPTION.-- organizationa mayl discourage i a e r 20 brand-nameA. pharmacy drugs or items by applying cost sharing to a t m m 21 brand-name drugs or items when at least one generic or d r e 22 therapeutic equivalent is covered within the same method of c e s k 23 contraception without patient cost sharing;

provided[Each] thatAn whenindividual e[and] aor ngroup b 24 an enrollee's health carea providert determinesm thatm a21 particularmaintenance uorganization [contract drugdelivered or itemissued isfor medicallyd necessary,r thee individual22 ordelivery groupin .232279.2this -state 33that -provides healtha maintenanceprescription organizationdrug contractc shalle covers thek brand-23 namebenefit pharmacyshall drugprovide, orat itema withoutminimum, costthe sharing.following coverage:

Medicale necessitya mayn includeb considerations24 such(1) asat severityleast ofone sideproduct effects, differences in permanence or reversibilityform of contraceptivesu and[ abilitycontraception toin adhereeach toof the appropriatecontraceptive usemethod ofcategories the.233817.3 drug- or34 item,- asSTBTC/SB determined189 identified by the attendingfederal provider.food and drug administration;

D.(2) a sufficient number and assortment of oral contraceptive pills to reflect the variety of oral contraceptives approved by the federal food and drug administration;

An[and] individual(3) orclinical groupservices healthrelated maintenanceto organizationthe contractprovision shallor grantuse anof enrolleecontraception, anincluding expeditedconsultations, hearingexaminations, toprocedures, appealultrasound, anyanesthesia, adversepatient determinationeducation, madecounseling, relatingdevice toinsertion theand provisionsremoval, offollow-up thiscare section.and side-effects management;

The(4) processa sufficient quantity to allow for requestingthe ancontinuous expediteduse hearingof pursuantclinically toappropriate thiscontraception subsectionas shall:determined by the prescribing provider;

(1)and be(5) easilyUnited accessible,States transparent,food sufficientlyand expedientdrug andadministration-approved, not-cleared undulyor burdensome-granted onover-the-counter ancontraception, enrollee,including thepoint-of-sale enrollee'scoverage representativefor orover-the- thee enrollee'st health17 carecounter provider;contraception at in-network dispensing entities.

(2)w deferl ton thed determination18 ofB. the e t 17 enrollee's health care provider;

andExcept was lprovided nin dSubsection 18C (3) provide for a determination of thethis claim = = 19 asection, lthe accordingcoverage torequired apursuant timeto framethis andsection inshall a mannerl that takes into i a e r 20 accountnot thebe naturesubject ofto: the claim and the medical exigencies a t m m 21 involved for a claim involving an urgent health care need.

da rt em 22m E.21 (1) enrollee cost sharing;

And individualr or group health maintenance c e s22 k(2) 23utilization organizationreview; contract shall not require a prescription for any e a n b 24 drug, item or service that is available without a prescription.

uc [e F.s k 23 (3) prior authorization or step-therapy e a n b 24 requirements;

An[or] individualu [ (4) quantity or groupfill healthlimits maintenanceif .232279.2the practice .233817.3 - 3435 - organizationSTBTC/SB contract189 shallwould provideresult coveragein andan shallenrollee reimbursereceiving less than a healthtwelve- caremonths' providerduration orof dispensingcontraception entitydispensed oneither aat per-one unittime basisor, forif dispensingrequested aby [six-month]the twelve-monthenrollee supplyat the point of contraceptivesdispensing, atover onea time;twelve-month period;

providedor that[(4)] the(5) contraceptivesany areother prescribedrestrictions andor self-administered.delays on the coverage.

G.C.

A health maintenance organization may discourage brand-name pharmacy drugs or items by applying cost sharing to brand-name drugs or items when at least one generic or therapeutic equivalent is covered within the same method of contraception without patient cost sharing;

provided that when an enrollee's health care provider determines that a particular drug or item is medically necessary, the individual or group health maintenance organization contract shall cover the brand- name pharmacy drug or item without cost sharing.

Medical necessity may include considerations such as severity of side e t 17 effects, differences in permanence or reversibility of w l n d 18 contraceptives and ability to adhere to the appropriate use of = = 19 the drug or item, as determined by the attending provider.

a l i a e r 20 D.

An individual or group health maintenance a t m m 21 organization contract shall grant an enrollee an expedited d r e 22 hearing to appeal any adverse determination made relating to c e s k 23 the provisions of this section.

The process for requesting an e a n b 24 expedited hearing pursuant to this subsection shall:

u [ (1) be easily accessible, transparent, .233817.3 - 36 - STBTC/SB 189 sufficiently expedient and not unduly burdensome on an enrollee, the enrollee's representative or the enrollee's health care provider;

(2) defer to the determination of the enrollee's health care provider;

and (3) provide for a determination of the claim according to a time frame and in a manner that takes into account the nature of the claim and the medical exigencies involved for a claim involving an urgent health care need.

E.

An individual or group health maintenance organization contract shall not require a prescription for any drug, item or service that is available without a prescription.

F.

An individual or group health maintenance organization contract shall provide coverage and shall reimburse a health care provider or dispensing entity on a per- unit basis for dispensing a [six-month] twelve-month supply of e t 17 contraceptives at one time;

provided that the contraceptives w l n d 18 are prescribed and self-administered.

= = 19 G.

a l i a e r 20 (1) require a health care provider to a t m m 21 prescribe [six] twelve months of contraceptives at one time;

or d r e 22 (2) permit an individual or group health c e s k 23 maintenance organization contract to limit coverage or impose e a n b 24 cost sharing for an alternate method of contraception if an u [ enrollee changes contraceptive methods before exhausting a .233817.3 - 37 - STBTC/SB 189 previously dispensed supply.

A religious entity purchasing individual or group health maintenance organization coverage may elect to exclude prescription contraceptive drugs or devices from the e t 17 health coverage purchased.

w l n d 18 [H.] I.

The provisions of this section shall not = = 19 a l apply to:

i a e r 20 (1) a high-deductible health benefit plan a t m m 21 issued or renewed in this state until an enrollee's deductible d r e 22 has been met;

or c e s k 23 (2) a short-term travel, an accident-only, a e a n b 24 hospital-indemnity-only, a limited-benefit or a specified u [ disease health benefits [plans] plan.

.232279.2 - 35 - [I.

The provisions of this section apply to individual or group health maintenance organization contracts delivered or issued for delivery after January 1, 2020.] e t 17 J.

w l n d 18 (1) "contraceptive method categories = = 19 identified by the federal food and drug administration":

a l i a e r 20 (a) means tubal ligation;

sterilization a t m m 21 implant;

intrauterine device with d r e 22 progestin;

c e s k 23 combined oral contraceptives;

extended or continuous use oral e a n b 24 contraceptives;

u [ vaginal ring;

sponge with .233817.3 - 38 - STBTC/SB 189 spermicide;

and any additional contraceptive method categories approved by the federal food e t 17 and drug administration;

and w l n d 18 (b) does not mean a product that has = = 19 a l been recalled for safety reasons or withdrawn from the market;

i a e r 20 (2) "cost sharing" means a deductible, a t m m 21 copayment or coinsurance that an enrollee is required to pay in d r e 22 accordance with the terms of an individual or group health c e s k 23 maintenance organization contract;

and e a n b 24 (3) "health care provider" means an individual u [ licensed to provide health care in the ordinary course of .232279.2 - 36 - business.

A religious entity purchasing individual or group health maintenance organization coverage may elect to e t 17 exclude prescription contraceptive drugs or devices from the w l n d 18 health coverage purchased.]" = = 19 SECTION 20.23.

A new section of the Health Maintenance a l i a e r 20 Organization Law is enacted to read:

a t m m 21 "[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.-- d r e 22 A.

An individual or group health maintenance c e s k 23 organization contract delivered or issued for delivery in this e a n b 24 state shall establish a special enrollment period to provide u [ coverage to an uninsured person if the person is eligible to be .233817.3 - 39 - STBTC/SB 189 insured and provides a certification from a health care provider to the insurer that the person is pregnant.

Coverage shall be effective before the end of the first month in which the person receives certification of e t 17 the pregnancy, unless the person elects to have coverage w l n d 18 effective on the first day of the month following the date that = = 19 a l the person makes a plan selection." i a e r 20 SECTION 21.24.

A new section of the Health Maintenance a t m m 21 Organization Law is enacted to read:

d r e 22 "[NEW MATERIAL] COVERAGE FOR GENDER-AFFIRMING CARE.--HEALTH cCARE.-- e s k 23 A.

An individual or group health maintenance e a n b 24 organization contract delivered or issued for delivery in this u [ state shall provide coverage for the total cost of gender- .232279.2 - 37 - affirming health care.

The coverage shall not be subject to cost-cost-sharing sharing provisions.

e t 17 B.

The provisions of this section shall not apply w l n d 18 to:

= = 19 (1) a high-deductible health benefit plan a l i a e r 20 issued or renewed in this state until an eligible enrollee's a t m m 21 deductible has been met;

or d r e 22 (2) a short-term travel, an accident-only, a c e s k 23 hospital-indemnity-only, a limited-benefit or a specified- e a n b 24 disease health care plan.

u [ C.

.233817.3 - 40 - STBTC/SB 189 (1) "cost sharing" means a deductible, copayment or coinsurance that an enrollee is required to pay in accordance with the terms of an individual or group health maintenance organization;

and (2) "gender-affirming health care" means apsychological, procedure,behavioral, esurgical, tpharmaceutical 17and service,medical drug,care, deviceservices orand productsupplies thatprovided a physical or behavioral w l n d 18 health care provider prescribes to treatsupport an individual for = = 19 a lperson's incongruence between the individual's gender identityidentity." and the i a e r 20 individual's sex assignment at birth." a t m m 21 SECTION 22.25.

A new section of the Nonprofit Health Care d r e 22 Plan Law is enacted to read:

c e s k 23 "[NEW MATERIAL] ABORTION CARE--NO COST SHARING.-- e a n b 24 A.

A health care plan delivered or issued for u [ delivery in this state shall provide coverage for the total .232279.2 - 38 - cost of abortion care that shall not be subject to cost- sharing provisions.

The provisions of this section shall not apply e t 17 to:

w l n d 18 (1) a high-deductible health benefit plan = = 19 issued or renewed in this state until an eligible subscriber's a l i a e r 20 deductible has been met;

or a t m m 21 (2) a short-term travel, an accident-only, a d r e 22 hospital-indemnity-only, a limited-benefit or a specified- c e s k 23 disease health care plan.

e a n b 24 C.

As used in this section, "cost sharing" means a u [ deductible, copayment or coinsurance that a subscriber is .233817.3 - 41 - STBTC/SB 189 required to pay in accordance with the terms of a health care plan." SECTION 23.26.

e t 17 "59A-47-45.5.

COVERAGE FOR CONTRACEPTION.-- w l n d 18 A.

A health care plan delivered or issued for = = 19 a l delivery in this state that provides a prescription drug i a e r 20 benefit shall provide, at a minimum, the following coverage:

a t m m 21 (1) at least one product or form of d r e 22 contraception in each of the contraceptive method categories c e s k 23 identified by the federal food and drug administration;

e a n b 24 (2) a sufficient number and assortment of oral u [ contraceptive pills to reflect the variety of oral .232279.2 - 39 - contraceptives approved by the federal food and drug administration;

[and] (3) clinical services related to the provision e t 17 or use of contraception, including consultations, examinations, w l n d 18 procedures, ultrasound, anesthesia, patient education, = = 19 counseling, device insertion and removal, follow-up care and a l i a e r 20 side-effects management;

a t m m 21 (4) a sufficient quantity to allow for the d r e 22 continuous use of clinically appropriate contraception as c e s k 23 determined by the prescribing provider;

and e a n b 24 (5) United States food and drug u [ administration-approved, -cleared or -granted over-the-counter .233817.3 - 42 - STBTC/SB 189 contraception, including point-of-sale coverage for over-the- counter contraception at in-network dispensing entities.

Except as provided in Subsection C of this section, the coverage required pursuant to this section shall e t 17 not be subject to:

w l n d 18 (1) cost sharing for subscribers;

= = 19 a l (2) utilization review;

i a e r 20 (3) prior authorization or step-therapy a t m m 21 requirements;

[or] d r e 22 (4) quantity or fill limits if the practice c e s k 23 would result in a subscriber receiving less than a twelve- e a n b 24 months' duration of contraception dispensed either at one time u [ or, if requested by the subscriber at the point of dispensing, .232279.2 - 40 - over a twelve-month period;

e t 17 C.

A health care plan may discourage brand-name w l n d 18 pharmacy drugs or items by applying cost sharing to brand-name = = 19 drugs or items when at least one generic or therapeutic a l i a e r 20 equivalent is covered within the same method category of a t m m 21 contraception without cost sharing by the subscriber;

provided d r e 22 that when a subscriber's health care provider determines that a c e s k 23 particular drug or item is medically necessary, the health care e a n b 24 plan shall cover the brand-name pharmacy drug or item without u [ cost sharing.

A determination of medical necessity may include .233817.3 - 43 - STBTC/SB 189 considerations such as severity of side effects, differences in permanence or reversibility of contraceptives and ability to adhere to the appropriate use of the drug or item, as determined by the attending provider.

e t 17 D.

A health care plan shall grant a subscriber an w l n d 18 expedited hearing to appeal any adverse determination made = = 19 a l relating to the provisions of this section.

The process for i a e r 20 requesting an expedited hearing pursuant to this subsection a t m m 21 shall:

d r e 22 (1) be easily accessible, transparent, c e s k 23 sufficiently expedient and not unduly burdensome on a e a n b 24 subscriber, the subscriber's representative or the subscriber's u [ health care provider;

.232279.2 - 41 - (2) defer to the determination of the subscriber's health care provider;

and (3) provide for a determination of the claim e t 17 according to a time frame and in a manner that takes into w l n d 18 account the nature of the claim and the medical exigencies = = 19 involved for a claim involving an urgent health care need.

a l i a e r 20 E.

A health care plan shall not require a a t m m 21 prescription for any drug, item or service that is available d r e 22 without a prescription.

c e s k 23 F.

A health care plan shall provide coverage and e a n b 24 shall reimburse a health care provider or dispensing entity on u [ a per unit basis for dispensing [a six-month supply of .233817.3 - 44 - STBTC/SB 189 contraceptives] contraception intended to last the subscriber for a duration of twelve months, as permitted by the subscriber's prescription, dispensed at one time;

e t 17 G.

w l n d 18 (1) require a health care provider to = = 19 a l prescribe [six] twelve months of contraceptives at one time;

i a e r 20 [or] a t m m 21 (2) permit a health care plan to limit d r e 22 coverage or impose cost sharing for an alternate method of c e s k 23 contraception if a subscriber changes contraceptive methods e a n b 24 before exhausting a previously dispensed supply;

or u [ (3) permit a plan or pharmacy benefits manager .232279.2 - 42 - to:

e t 17 or w l n d 18 (b) deny coverage for the continuous use = = 19 of clinically appropriate contraception as determined by the a l i a e r 20 prescribing provider.

a t m m 21 H.

A religious entity purchasing individual or d r e 22 group health care plan may elect to exclude prescription c e s k 23 contraceptive drugs or devices from the health coverage e a n b 24 purchased.

u [ [H.] I.

The provisions of this section shall not .233817.3 - 45 - STBTC/SB 189 apply to:

or e t 17 (2) a short-term travel, an accident-only, a w l n d 18 hospital-indemnity-only, a limited-benefit or a specified- = = 19 a l disease health care [plans] plan.

i a e r 20 [I.

The provisions of this section apply to health a t m m 21 care plans delivered or issued for delivery after January 1, d r e 22 2020.] c e s k 23 J.

e a n b 24 (1) "contraceptive method categories u [ identified by the federal food and drug administration":

.232279.2 - 43 - (a) means tubal ligation;

e t 17 combined oral contraceptives;

extended or continuous use oral w l n d 18 contraceptives;

= = 19 vaginal ring;

sponge with a l i a e r 20 spermicide;

male and female a t m m 21 condoms;

d r e 22 levonorgestrel emergency contraception;

and any additional c e s k 23 contraceptive method categories approved by the federal food e a n b 24 and drug administration;

and u [ (b) does not mean a product that has .233817.3 - 46 - STBTC/SB 189 been recalled for safety reasons or withdrawn from the market;

and e t 17 (3) "health care provider" means an individual w l n d 18 licensed to provide health care in the ordinary course of = = 19 a l business.

i a e r 20 [K.

A religious entity purchasing individual or a t m m 21 group health care plan coverage may elect to exclude d r e 22 prescription contraceptive drugs or items from the health c e s k 23 insurance coverage purchased.]" e a n b 24 SECTION 24.27.

A new section of the Nonprofit Health Care u [ Plan Law is enacted to read:

.232279.2 - 44 - "[NEW MATERIAL] SPECIAL ENROLLMENT PERIOD--PREGNANCY.-- A.

A health care plan delivered or issued for delivery in this state shall establish a special enrollment period to provide coverage to an uninsured person if the person is eligible to be insured and provides a certification from a health care provider to the insurer that the person is pregnant.

B.

Coverage shall be effective before the end of the first month in which the uninsured person receives certification of the pregnancy, unless the person elects to have coverage effective on the first day of the month following the date that the person makes a plan selection." SECTION 25.

"[NEW MATERIAL] COVERAGESPECIAL FORENROLLMENT GENDER-AFFIRMINGPERIOD--PREGNANCY.-- CARE.-- A.

A health care plan delivered or issued for e t 17 delivery in this state shall establish a special enrollment e t 17 period to provide coverage forto an uninsured person if the totalperson w l n d 18 costis ofeligible gender-affirmingto care.be insured and provides a certification from a = = 19 health care provider to the insurer that the person is a l i a e r 20 pregnant.

The coverage shall not be = = 19 a lt subjectm tom cost-sharing21 provisions.B.

iCoverage ashall ebe effective before the end of d r 20e B.22 the first month in which the uninsured person receives c e s k 23 certification of the pregnancy, unless the person elects to e a n b 24 have coverage effective on the first day of the month following u [ the date that the person makes a plan selection." .233817.3 - 47 - STBTC/SB 189 SECTION 28.

TheA provisionsnew section of thisthe sectionNonprofit shallHealth notCare applyPlan aLaw tis menacted mto 21read: to:

d"[NEW rMATERIAL] eCOVERAGE 22FOR (1)GENDER-AFFIRMING aHEALTH high-deductibleCARE.-- healthA. benefit plan c e s k 23 issued or renewed in this state until an eligible subscriber's e a n b 24 deductible has been met;

orA uhealth [care (2)plan adelivered short-termor travel,issued anfor accident-only,delivery ain .232279.2this -state 45shall -provide hospital-indemnity-only,coverage afor limited-benefitthe ortotal acost specified-of diseasegender-affirming health carecare. plan.

C.The coverage shall not be subject to cost-sharing provisions.

B.

The provisions of this section shall not apply to:

(1) a high-deductible health benefit plan issued or renewed in this state until an eligible subscriber's deductible has been met;

or (2) a short-term travel, an accident-only, a hospital-indemnity-only, a limited-benefit or a specified- disease health care plan.

e t 17 C.

w l n d 18 (1) "cost sharing" means a deductible, = = 19 copayment or coinsurance that a subscriber is required to pay a l i a e r 20 in accordance with the terms of a health care plan;

and a t m m 21 (2) "gender-affirming health care" means ad procedure,r service,e drug,22 devicepsychological, orbehavioral, productsurgical, thatpharmaceutical aand physicalmedical orc behaviorale healths carek provider23 prescribescare, toservices treatand ansupplies individualprovided forto incongruencesupport betweena theperson's individual'se gendera identityn andb the24 individual'sgender sexidentity." assignmentu at[ birth." SECTION 26.29.

APPLICABILITY.--The provisions of Sections 1 .233817.3 - 48 - STBTC/SB 189 through 7, 9 through 18 and 21 through 28 of this act apply to policies, plans, contracts and certificates delivered or issued for delivery or renewed, extended or amended in this state beginning January 1, 2027.

- 4649 - 7 9 11 13 15 e t 17 w l n d 18 = = 19 a l i a e r 20 a t m m 21 d r e 22 c e s k 23 e a n b 24 u [ .232279.2.233817.3