A health benefit plan may provide coverage for elective 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) the enrollee pays the premium for coverage for elective abortion separately from, and in addition to, the premium for other health benefit plan coverage, if any; and
(3) the enrollee provides a signature for coverage for elective abortion, separately and distinct from the signature required for other health benefit plan coverage, if any, provided to the enrollee by the health benefit plan issuer.