reglab/housing_qa huggingface dataset:
TX Ins Code § 1362.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1362 - Certain Tests for Detection of Prostate Cancer|Section 1362.002. Exception

Sec. 1362.002.  EXCEPTION.  This chapter 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;  or(E)  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 1362.001.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1362.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1362 - Certain Tests for Detection of Prostate Cancer|Section 1362.003. Coverage Required

Sec. 1362.003.  COVERAGE REQUIRED.  (a)  A health benefit plan that provides coverage for diagnostic medical procedures must provide to each male enrolled in the plan coverage for expenses for an annual medically recognized diagnostic examination for the detection of prostate cancer.(b)  Coverage required under this section includes at a minimum:(1)  a physical examination for the detection of prostate cancer;  and(2)  a prostate-specific antigen test used for the detection of prostate cancer for each male who:(A)  is at least 50 years of age and is asymptomatic;  or(B)  is at least 40 years of age and has a family history of prostate cancer or another prostate cancer risk factor.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1362.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1362 - Certain Tests for Detection of Prostate Cancer|Section 1362.004. Notice of Coverage

Sec. 1362.004.  NOTICE OF COVERAGE.  (a)  A health benefit plan issuer shall provide to each individual enrolled in the plan written notice of the coverage required under this chapter.(b)  The notice must be provided in accordance with rules adopted by the commissioner.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1362.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1362 - Certain Tests for Detection of Prostate Cancer|Section 1362.005. Rules

Sec. 1362.005.  RULES.  The commissioner shall adopt rules necessary to administer this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1363.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1363 - Certain Tests for Detection of Colorectal Cancer|Section 1363.001. Applicability of Chapter

Sec. 1363.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage that is provided by a health group cooperative under Subchapter B of that chapter, that:(1)  provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:(A)  an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage that is offered by:(i)  an insurance company;(ii)  a group hospital service corporation operating under Chapter 842;(iii)  a fraternal benefit society operating under Chapter 885;(iv)  a Lloyd's plan operating under Chapter 941;(v)  a stipulated premium company operating under Chapter 884;(vi)  a health maintenance organization operating under Chapter 843; or(vii)  a reciprocal or interinsurance exchange operating under Chapter 942; and(B)  to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:(i)  a multiple employer welfare arrangement as defined by Section 3 of that Act; or(ii)  another analogous benefit arrangement;(2)  is offered by an approved nonprofit health corporation operating under Chapter 844; or(3)  provides health and accident coverage through a risk pool created under Chapter 172, Local Government Code, notwithstanding Section 172.014, Local Government Code, or any other law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2021, 87th Leg., R.S., Ch. 308 (S.B. 1028), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 1363.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1363 - Certain Tests for Detection of Colorectal Cancer|Section 1363.002. Exception

Sec. 1363.002.  EXCEPTION.  This chapter does not apply to:(1)  a plan that provides coverage:(A)  only for a specified disease or other 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)  only for indemnity for hospital confinement; or(F)  only for dental or vision care;(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 credit-only insurance policy;(4)  a workers' compensation insurance policy;(5)  medical payment insurance coverage provided under a motor vehicle 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 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 1363.001.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2021, 87th Leg., R.S., Ch. 308 (S.B. 1028), Sec. 2, eff. September 1, 2021.|
TX Ins Code § 1363.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1363 - Certain Tests for Detection of Colorectal Cancer|Section 1363.003. Minimum Coverage Required

Sec. 1363.003.  MINIMUM COVERAGE REQUIRED.  (a)  A health benefit plan that provides coverage for screening medical procedures must provide to each individual enrolled in the plan who is 45 years of age or older and at normal risk for developing colon cancer coverage for expenses incurred in conducting a medically recognized screening examination for the detection of colorectal cancer.(b)  The minimum coverage required under this section must include:(1)  all colorectal cancer examinations, preventive services, and laboratory tests assigned a grade of "A" or "B" by the United States Preventive Services Task Force for average-risk individuals, including the services that may be assigned a grade of "A" or "B" in the future; and(2)  an initial colonoscopy or other medical test or procedure for colorectal cancer screening and a follow-up colonoscopy if the results of the initial colonoscopy, test, or procedure are abnormal.(c)  For an enrollee in a managed care plan as defined by Section 1451.151, the plan may impose a cost-sharing requirement for coverage described by this section only if the enrollee obtains the covered benefit or service outside the plan's network.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2021, 87th Leg., R.S., Ch. 308 (S.B. 1028), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1363.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1363 - Certain Tests for Detection of Colorectal Cancer|Section 1363.004. Notice of Coverage

Sec. 1363.004.  NOTICE OF COVERAGE.  (a)  A health benefit plan issuer shall provide to each individual enrolled in the plan written notice of the coverage required under this chapter.(b)  The notice must be provided in accordance with rules adopted by the commissioner.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1363.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1363 - Certain Tests for Detection of Colorectal Cancer|Section 1363.005. Rules

Sec. 1363.005.  RULES.  The commissioner shall adopt rules as necessary to administer this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1365.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1365 - Loss or Impairment of Speech or Hearing|Section 1365.001. Applicability of Chapter

Sec. 1365.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to a group health benefit plan that provides hospital and medical coverage on an expense-incurred, service, or prepaid basis, including a group policy, contract, or plan that is offered in this state by:(1)  an insurer;(2)  a group hospital service corporation operating under Chapter 842;  or(3)  a health maintenance organization operating under Chapter 843.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1365.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1365 - Loss or Impairment of Speech or Hearing|Section 1365.002. Applicability of General Provisions of Other Law

Sec. 1365.002.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW.  The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, construction of policies under that chapter, rulemaking under that chapter, and definitions of terms applicable in that chapter, apply to this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1365.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1365 - Loss or Impairment of Speech or Hearing|Section 1365.003. Offer of Coverage Required

Sec. 1365.003.  OFFER OF COVERAGE REQUIRED.  (a)  A group health benefit plan issuer shall offer and make available under the plan coverage for the necessary care and treatment of loss or impairment of speech or hearing.(b)  Coverage required under this section:(1)  may not be less favorable than coverage for physical illness generally under the plan;  and(2)  must be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors as coverage for physical illness generally under the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1365.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1365 - Loss or Impairment of Speech or Hearing|Section 1365.004. Right to Reject Coverage or Select Alternative Benefits

Sec. 1365.004.  RIGHT TO REJECT COVERAGE OR SELECT ALTERNATIVE BENEFITS.  An offer of coverage required under Section 1365.003 is subject to the right of the group contract holder to reject the coverage or to select an alternative level of benefits that is offered by or negotiated with the group health benefit plan issuer.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.028, eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.028, eff. September 1, 2007.|
TX Ins Code § 1368.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.001. Definitions

Sec. 1368.001.  DEFINITIONS.  In this chapter:(1)  "Chemical dependency" means the abuse of, a psychological or physical dependence on, or an addiction to alcohol or a controlled substance.(2)  "Chemical dependency treatment center" means a facility that provides a program for the treatment of chemical dependency under a written treatment plan approved and monitored by a physician and that is:(A)  affiliated with a hospital under a contractual agreement with an established system for patient referral;(B)  accredited as a chemical dependency treatment center by the Joint Commission on Accreditation of Healthcare Organizations;(C)  licensed as a chemical dependency treatment program by the Texas Commission on Alcohol and Drug Abuse;  or(D)  licensed, certified, or approved as a chemical dependency treatment program or center by another state agency.(3)  "Controlled substance" means an abusable volatile chemical, as defined by Section 485.001, Health and Safety Code, or a substance designated as a controlled substance under Chapter 481, Health and Safety Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.002. Applicability of Chapter

Sec. 1368.002.  APPLICABILITY OF CHAPTER.  This chapter applies only to a group health benefit plan that provides hospital and medical coverage or services on an expense incurred, service, or prepaid basis, including a group insurance policy or contract or self-funded or self-insured plan or arrangement that is offered in this state by:(1)  an insurer;(2)  a group hospital service corporation operating under Chapter 842;(3)  a health maintenance organization operating under Chapter 843;  or(4)  an employer, trustee, or other self-funded or self-insured plan or arrangement.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.003. Exception

Sec. 1368.003.  EXCEPTION.  This chapter does not apply to:(1)  an employer, trustee, or other self-funded or self-insured plan or arrangement with 250 or fewer employees or members;(2)  an individual insurance policy;(3)  an individual evidence of coverage issued by a health maintenance organization;(4)  a health insurance policy that provides only:(A)  cash indemnity for hospital or other confinement benefits;(B)  supplemental or limited benefit coverage;(C)  coverage for specified diseases or accidents;(D)  disability income coverage;  or(E)  any combination of those benefits or coverages;(5)  a blanket insurance policy;(6)  a short-term travel insurance policy;(7)  an accident-only insurance policy;(8)  a limited or specified disease insurance policy;(9)  an individual conversion insurance policy or contract;(10)  a policy or contract designed for issuance to a person eligible for Medicare coverage or other similar coverage under a state or federal government plan;  or(11)  an evidence of coverage provided by a health maintenance organization if the plan holder is the subject of a collective bargaining agreement that was in effect on January 1, 1982, and that has not expired since that date.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.004. Coverage Required

Sec. 1368.004.  COVERAGE REQUIRED.  (a)  A group health benefit plan shall provide coverage for the necessary care and treatment of chemical dependency.(b)  Coverage required under this section may be provided:(1)  directly by the group health benefit plan issuer;  or(2)  by another entity, including a single service health maintenance organization, under contract with the group health benefit plan issuer.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.005. Minimum Coverage Requirements

Sec. 1368.005.  MINIMUM COVERAGE REQUIREMENTS.  (a)  Except as provided by Subsection (b), coverage required under this chapter:(1)  may not be less favorable than coverage provided for physical illness generally under the plan;  and(2)  shall be subject to the same durational limits, dollar limits, deductibles, and coinsurance factors that apply to coverage provided for physical illness generally under the plan.(b)  A group health benefit plan may set dollar or durational limits for coverage required under this chapter that are less favorable than for coverage provided for physical illness generally under the plan if those limits are sufficient to provide appropriate care and treatment under the guidelines and standards adopted under Section 1368.007.  If guidelines and standards adopted under Section 1368.007 are not in effect, the dollar and durational limits may not be less favorable than for physical illness generally.(c)  This section does not require payment of a usual, customary, and reasonable rate for treatment of a covered individual if a health maintenance organization or preferred provider organization establishes a negotiated rate for the locality in which the covered individual customarily receives care.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.006. Limitation on Coverage

Sec. 1368.006.  LIMITATION ON COVERAGE.  (a)  In this section, "treatment series" means a planned, structured, and organized program to promote chemical-free status that:(1)  may include different facilities or modalities;  and(2)  is completed when the covered individual:(A)  is, on medical advice, discharged from:(i)  inpatient detoxification;(ii)  inpatient rehabilitation or treatment;(iii)  partial hospitalization or intensive outpatient treatment;  or(iv)  a series of those levels of treatments without a lapse in treatment;  or(B)  fails to materially comply with the treatment program for a period of 30 days.(b)  Notwithstanding Section 1368.005, coverage required under this chapter is limited to a lifetime maximum of three separate treatment series for each covered individual.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.007 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.007. Treatment Standards

Sec. 1368.007.  TREATMENT STANDARDS.  (a)  Coverage provided under this chapter for necessary care and treatment in a chemical dependency treatment center must be provided as if the care and treatment were provided in a hospital.(b)  The department by rule shall adopt standards formulated and approved by the department and the Texas Commission on Alcohol and Drug Abuse for use by insurers, other third-party reimbursement sources, and chemical dependency treatment centers.(c)  Standards adopted under this section must provide for:(1)  reasonable control of costs necessary for inpatient and outpatient treatment of chemical dependency, including guidelines for treatment periods;  and(2)  appropriate utilization review of treatment as well as necessary extensions of treatment.(d)  Coverage required under this chapter is subject to the standards adopted under this section.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1368.008 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1368 - Availability of Chemical Dependency Coverage|Section 1368.008. Use of Endorsement or Rider to Comply With Chapter

Sec. 1368.008.  USE OF ENDORSEMENT OR RIDER TO COMPLY WITH CHAPTER.  A group health benefit plan issuer that uses a policy form approved by the commissioner before November 10, 1981, may use an endorsement or rider to comply with this chapter if the endorsement or rider is approved by the commissioner as complying with this chapter and other provisions of this code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1370.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1370 - Certain Tests for Detection of Human Papillomavirus, Ovarian Cancer, and Cervical Cancer|Section 1370.001. Applicability of Chapter

Sec. 1370.001.  APPLICABILITY OF CHAPTER.  (a)  This chapter 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, an individual or group evidence of coverage, or a 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 health maintenance organization operating under Chapter 843;(6)  a reciprocal exchange operating under Chapter 942;(7)  a Lloyd's plan operating under Chapter 941;(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or(9)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846.(b)  This chapter applies to a small employer health benefit plan written under Chapter 1501.|Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.|