Senate Bill 245 addressing abortion, abortion related services, cost sharing and utilization management, including prior authorizations

As a reminder, Senate Bill 245, codified as Section 1367.251 of the Health and Safety Code, effective January 1, 2023, requires that health plans, and their delegates, not impose, except for high deductible plan cost sharing limits described below, a deductible, coinsurance, copayment, or any other cost-sharing requirement on coverage for all abortion and abortion-related services, including pre-abortion and follow-up services. It provides that except as otherwise authorized by this law, a health plan shall not impose any utilization management or utilization review, including prior authorization and annual or lifetime limits consistent with Sections 1367.001 and 1367.005 of the Health and Safety Code, on the coverage for outpatient abortion services.

 

The law does not require a health plan to cover an experimental or investigational treatment. Abortion is defined as any medical treatment intended to induce the termination of a pregnancy except for the purpose of producing a live birth.

 

The law provides that for a high deductible health plan, the cost-sharing limits described in the law shall apply once an enrollee’s deductible has been satisfied for the benefit year.

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