reglab/housing_qa huggingface dataset:
TX Ins Code § 1369.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.102. Applicability of Subchapter

Sec. 1369.102.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501, 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)  a reciprocal 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.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.103. Exception

Sec. 1369.103.  EXCEPTION.  This subchapter does not apply to:(1)  a health benefit plan that provides coverage only:(A)  for a specified disease or for another limited benefit other than for cancer;(B)  for accidental death or dismemberment;(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(D)  as a supplement to a liability insurance policy;(E)  for credit insurance;(F)  for dental or vision care;  or(G)  for indemnity for hospital confinement;(2)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), as amended;(3)  a workers' compensation insurance policy;(4)  medical payment insurance coverage provided under a motor vehicle insurance policy;  or(5)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1369.102.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.104. Exclusion or Limitation Prohibited

Sec. 1369.104.  EXCLUSION OR LIMITATION PROHIBITED.  (a)  A health benefit plan that provides benefits for prescription drugs or devices may not exclude or limit benefits to enrollees for:(1)  a prescription contraceptive drug or device approved by the United States Food and Drug Administration;  or(2)  an outpatient contraceptive service.(b)  This section does not prohibit a limitation that applies to all prescription drugs or devices or all services for which benefits are provided under a health benefit plan.(c)  This section does not require a health benefit plan to cover abortifacients or any other drug or device that terminates a pregnancy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.105 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.105. Certain Cost-Sharing Provisions Prohibited

Sec. 1369.105.  CERTAIN COST-SHARING PROVISIONS PROHIBITED.  (a)  A health benefit plan may not impose a deductible, copayment, coinsurance, or other cost-sharing provision applicable to benefits for prescription contraceptive drugs or devices unless the amount of the required cost-sharing is the same as or less than the amount of the required cost-sharing applicable to benefits for other prescription drugs or devices under the plan.(b)  A health benefit plan may not impose a deductible, copayment, coinsurance, or other cost-sharing provision applicable to benefits for outpatient contraceptive services unless the amount of the required cost-sharing is the same as or less than the amount of the required cost-sharing applicable to benefits for other outpatient services under the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.106 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.106. Certain Waiting Periods Prohibited

Sec. 1369.106.  CERTAIN WAITING PERIODS PROHIBITED.  (a)  A health benefit plan may not impose a waiting period applicable to benefits for prescription contraceptive drugs or devices unless the waiting period is the same as or shorter than any waiting period applicable to benefits for other prescription drugs or devices under the plan.(b)  A health benefit plan may not impose a waiting period applicable to benefits for outpatient contraceptive services unless the waiting period is the same as or shorter than any waiting period applicable to benefits for other outpatient services under the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.107 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.107. Prohibited Conduct

Sec. 1369.107.  PROHIBITED CONDUCT.  A health benefit plan issuer may not:(1)  solely because of the applicant's or enrollee's use or potential use of a prescription contraceptive drug or device or an outpatient contraceptive service, deny:(A)  the eligibility of an applicant to enroll in the plan;(B)  the continued eligibility of an enrollee for coverage under the plan;  or(C)  the eligibility of an enrollee to renew coverage under the plan;(2)  provide a monetary incentive to an applicant for enrollment or an enrollee to induce the applicant or enrollee to accept coverage that does not satisfy the requirements of this subchapter;  or(3)  reduce or limit a payment to a health care professional, or otherwise penalize the professional, because the professional prescribes a contraceptive drug or device or provides an outpatient contraceptive service.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.108 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.108. Exemption for Entities Associated With Religious Organization

Sec. 1369.108.  EXEMPTION FOR ENTITIES ASSOCIATED WITH RELIGIOUS ORGANIZATION.  (a)  This subchapter does not require a health benefit plan that is issued by an entity associated with a religious organization or any physician or health care provider providing medical or health care services under the plan to offer, recommend, offer advice concerning, pay for, provide, assist in, perform, arrange, or participate in providing or performing a medical or health care service that violates the religious convictions of the organization, unless the prescription contraceptive coverage is necessary to preserve the life or health of the enrollee.(b)  An issuer of a health benefit plan that excludes or limits coverage for medical or health care services under this section shall state the exclusion or limitation in:(1)  the plan's coverage document;(2)  the plan's statement of benefits;(3)  plan brochures;  and(4)  other informational materials for the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.109 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter C. Coverage of Prescription Contraceptive Drugs and Devices and Related Services|Section 1369.109. Enforcement

Sec. 1369.109.  ENFORCEMENT.  A health benefit plan issuer that violates this subchapter is subject to the enforcement provisions of Subtitle B, Title 2.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.151 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter D. Pharmacy Benefit Cards|Section 1369.151. Applicability of Subchapter

Sec. 1369.151.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter 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)  a reciprocal 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)  Notwithstanding any other law, this subchapter applies to coverage under:(1)  the basic coverage plan under Chapter 1551;(2)  the basic plan under Chapter 1575;(3)  the primary care coverage plan under Chapter 1579;(4)  the basic coverage plan under Chapter 1601;(5)  the child health plan program under Chapter 62, Health and Safety Code; and(6)  the medical assistance program under Chapter 32, Human Resources Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1117 (H.B. 1138), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1369.152 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter D. Pharmacy Benefit Cards|Section 1369.152. Exception

Sec. 1369.152.  EXCEPTION.  This subchapter does not apply to:(1)  a health benefit plan that provides coverage:(A)  only for a specified disease or for another limited benefit;(B)  only for accidental death or dismemberment;(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(D)  as a supplement to a liability insurance policy;(E)  for credit insurance;(F)  only for dental or vision care;(G)  only for hospital expenses;  or(H)  only for indemnity for hospital confinement;(2)  a small employer health benefit plan written under Chapter 1501;(3)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);(4)  a workers' compensation insurance policy;(5)  medical payment insurance coverage provided under a motor vehicle insurance policy;  or(6)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1369.151.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter D. Pharmacy Benefit Cards|Section 1369.153. Information Required on Identification Card

Sec. 1369.153.  INFORMATION REQUIRED ON IDENTIFICATION CARD.  (a)  An issuer of a health benefit plan that provides pharmacy benefits to enrollees shall include on the front of the identification card of each enrollee:(1)  the name of the entity administering the pharmacy benefits if the entity is different from the health benefit plan issuer;(2)  the group number applicable to the enrollee;(3)  the identification number of the enrollee, which may not be the enrollee's social security number;(4)  the bank identification number necessary for electronic billing;(5)  the effective date of the coverage evidenced by the card; and(6)  copayment information for generic and brand-name prescription drugs.(b)  In addition to the information required under Subsection (a), the issuer of a health benefit plan shall include on the identification card of each enrollee:(1)  the logo of the entity administering the pharmacy benefits if the entity is different from the health benefit plan issuer; and(2)  a telephone number for contacting an appropriate person to obtain information relating to the pharmacy benefits provided under the plan.(c)  In addition to complying with Subsections (a) and (b), an issuer of a health benefit plan may provide the information required under Subsections (a) and (b) in electronically readable form on the back of the identification card.(d)  This section does not require a health benefit plan issuer that administers its own pharmacy benefits to issue an identification card separate from any identification card issued to an enrollee to evidence coverage under the plan if the identification card issued to evidence coverage contains the information required by Subsections (a) and (b).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1117 (H.B. 1138), Sec. 2, eff. September 1, 2009.|
TX Ins Code § 1369.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter D. Pharmacy Benefit Cards|Section 1369.154. Rules

Sec. 1369.154.  RULES.  (a)  The commissioner shall adopt rules as necessary to implement this subchapter.(b)  Rules adopted by the commissioner must be consistent with national standards established by the Workgroup for Electronic Data Interchange or by other similar organizations recognized by the commissioner.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 1117 (H.B. 1138), Sec. 3, eff. September 1, 2009.|
TX Ins Code § 1369.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter E. Coverage for Orally Administered Anticancer Medications|Section 1369.201. Definitions

Sec. 1369.201.  DEFINITIONS.  In this subchapter:(1)  "Health benefit exchange" means an American Health Benefit Exchange administered by the federal government or created pursuant to Section 1311(b), Patient Protection and Affordable Care Act (42 U.S.C. Section 18031).(2)  "Qualified health plan" has the meaning assigned by Section 1301(a), Patient Protection and Affordable Care Act (42 U.S.C. Section 18021).|Added by Acts 2011, 82nd Leg., R.S., Ch. 105 (H.B. 438), Sec. 1, eff. September 1, 2011.|
TX Ins Code § 1369.202 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter E. Coverage for Orally Administered Anticancer Medications|Section 1369.202. Applicability of Subchapter

Sec. 1369.202.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage provided by a health group cooperative under Subchapter B of that chapter, 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 Lloyd's plan operating under Chapter 941;(7)  a health maintenance organization operating under Chapter 843; or(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.|Added by Acts 2011, 82nd Leg., R.S., Ch. 105 (H.B. 438), Sec. 1, eff. September 1, 2011.|
TX Ins Code § 1369.203 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter E. Coverage for Orally Administered Anticancer Medications|Section 1369.203. Exception

Sec. 1369.203.  EXCEPTION.  (a)  This subchapter does not apply to:(1)  a plan that provides coverage:(A)  only for fixed indemnity benefits for a specified disease or diseases;(B)  only for accidental death or dismemberment;(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(D)  as a supplement to a liability insurance policy;(E)  only for dental or vision care; or(F)  only for indemnity for hospital confinement;(2)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);(3)  a workers' compensation insurance policy;(4)  medical payment insurance coverage provided under an automobile insurance policy;(5)  a credit insurance policy;(6)  a limited benefit policy that does not provide coverage for physical examinations or wellness exams;(7)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or(8)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1369.201.(b)  This subchapter does not apply to a qualified health plan offered through a health benefit exchange.|Added by Acts 2011, 82nd Leg., R.S., Ch. 105 (H.B. 438), Sec. 1, eff. September 1, 2011.|
TX Ins Code § 1369.204 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter E. Coverage for Orally Administered Anticancer Medications|Section 1369.204. Required Coverage for Orally Administered Anticancer Medications

Sec. 1369.204.  REQUIRED COVERAGE FOR ORALLY ADMINISTERED ANTICANCER MEDICATIONS.  (a)  A health benefit plan that provides coverage for cancer treatment must provide coverage for a prescribed, orally administered anticancer medication that is used to kill or slow the growth of cancerous cells on a basis no less favorable than intravenously administered or injected cancer medications that are covered as medical benefits by the plan.(b)  This section does not prohibit a health benefit plan from requiring prior authorization for an orally administered anticancer medication.  If an orally administered anticancer medication is authorized, the cost to the covered individual may not exceed the coinsurance or copayment that would be applied to a chemotherapy or other cancer treatment visit.(c)  A health benefit plan issuer may not reclassify anticancer medications or increase a coinsurance, copayment, deductible, or other out-of-pocket expense imposed on anticancer medications to achieve compliance with this section. Any plan change that otherwise increases an out-of-pocket expense applied to anticancer medications must also be applied to the majority of comparable medical or pharmaceutical benefits under the plan.(d)  This section does not prohibit a health benefit plan issuer from increasing cost-sharing for all benefits, including anticancer treatments.|Added by Acts 2011, 82nd Leg., R.S., Ch. 105 (H.B. 438), Sec. 1, eff. September 1, 2011.|
TX Ins Code § 1369.211 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter E. -1. Coverage of Prescription Drugs for Stage-Four Advanced, Metastatic Cancer|Section 1369.211. Definitions

Sec. 1369.211.  DEFINITIONS.  In this subchapter:(1)  "Associated conditions" means the symptoms or side effects associated with stage-four advanced, metastatic cancer or its treatment and which, in the judgment of the health care practitioner, further jeopardize the health of a patient if left untreated.(2)  "Stage-four advanced, metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes, or other areas or parts of the body.|Added by Acts 2019, 86th Leg., R.S., Ch. 1350 (H.B. 1584), Sec. 1, eff. September 1, 2019.|