reglab/housing_qa huggingface dataset:
TX Ins Code § 1652.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter D. Consumer Information and Notice|Section 1652.154. Notice Relating to Other Types of Coverage

Sec. 1652.154.  NOTICE RELATING TO OTHER TYPES OF COVERAGE.  (a)  The commissioner may adopt reasonable rules for captions or notice requirements for each accident and health insurance policy, subscriber contract, or evidence of coverage sold to an individual eligible for Medicare that are determined to be in the public interest and designed to inform the individual that a particular coverage is not a Medicare supplement benefit plan.  This subsection does not apply to:(1)  a Medicare supplement benefit plan;(2)  a disability income policy;(3)  a basic, catastrophic, or major medical expense policy;(4)  a single premium nonrenewable policy;  or(5)  another policy, contract, or subscriber contract described by Section 1652.002(b)(1) or (2).(b)  The commissioner may adopt reasonable rules to govern the full and fair disclosure of information relating to replacing an accident and health insurance policy, a subscriber contract, or a certificate by an individual eligible for Medicare.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.155 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter D. Consumer Information and Notice|Section 1652.155. Right to Return for Refund; Notice

Sec. 1652.155.  RIGHT TO RETURN FOR REFUND;  NOTICE.  (a)  If an applicant is not satisfied for any reason after examining a Medicare supplement benefit plan document or certificate, the applicant is entitled to receive a refund of the premium if the applicant returns the document or certificate not later than the 30th day after the date it is delivered.(b)  The entity issuing the plan or certificate shall refund the premium directly to the applicant in a timely manner.(c)  A Medicare supplement benefit plan or certificate must have a notice stating the substance prescribed by Subsection (a) prominently printed on the first page of or attached to the plan or certificate.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.156 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter D. Consumer Information and Notice|Section 1652.156. Advertising Filing Requirements

Sec. 1652.156.  ADVERTISING FILING REQUIREMENTS.  (a)  The commissioner shall adopt reasonable rules to require each entity described by Section 1652.003 to file with the department a copy of any advertisement relating to Medicare supplement benefit plans that the entity intends to use in this state.  The rules must require that the entity file the copy not later than the 60th day before the date of intended use.(b)  At the expiration of the 60-day period provided by Subsection (a), an advertisement filed in accordance with that subsection is considered acceptable, unless before the end of that 60-day period the department notifies the entity of the advertisement's nonacceptance.(c)  An entity may not use an advertisement for Medicare supplement benefit plans that does not comply with state law, including department rules and Section 541.084.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 475 (H.B. 2251), Sec. 3, eff. September 1, 2007.|
TX Ins Code § 1652.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter E. Agents|Section 1652.201. Information Provided to Agents

Sec. 1652.201.  INFORMATION PROVIDED TO AGENTS.  (a)  An entity that offers a Medicare supplement benefit plan for sale in this state shall provide to each agent authorized to sell that plan information relating to:(1)  Medicare;(2)  the Medicare supplement benefit plans offered by that entity;  and(3)  the agent's ethical obligations to clients.(b)  The commissioner by rule may prescribe the information that must be provided under this section.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.202 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter E. Agents|Section 1652.202. Permitted Compensation Arrangements

Sec. 1652.202.  PERMITTED COMPENSATION ARRANGEMENTS.  (a)  The commissioner by rule shall limit the commission or other compensation that may be paid to an agent for the sale of a Medicare supplement benefit plan or certificate, including a replacement plan or certificate.(b)  The rules must conform to, but may not be more restrictive than, the requirements of federal law necessary for this state to obtain or retain certification as a state with an approved regulatory program.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.251 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter F. Outpatient Prescription Drugs|Section 1652.251. Outpatient Prescription Drug Benefit Plans

Sec. 1652.251.  OUTPATIENT PRESCRIPTION DRUG BENEFIT PLANS.  (a)  An entity described by Section 1652.003 that issues a Medicare supplement benefit plan in this state may offer a group or individual policyholder:(1)  an outpatient prescription drug benefit plan authorized under 42 U.S.C. Section 1395ss; or(2)  a new or innovative outpatient prescription drug benefit plan filed with and approved by the commissioner under Section 1652.055.(b)  The commissioner shall approve or disapprove an outpatient drug benefit plan described by Subsection (a) that is filed for approval under Section 1652.055 not later than the 60th day after the date the entity files the plan with the department. A drug benefit plan that has not been approved or disapproved by the commissioner before the 61st day after the date the plan is filed with the department is considered approved on that day.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.075(a), eff. September 1, 2005.|
TX Ins Code § 1652.252 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1652 - Medicare Supplement Benefit Plans|Subchapter F. Outpatient Prescription Drugs|Section 1652.252. Prescription Drug Discount Programs

Sec. 1652.252.  PRESCRIPTION DRUG DISCOUNT PROGRAMS.  (a)  In this section, "prescription drug discount program" means any program that entitles a participant to purchase prescription drugs or other medical supplies and services from vendors at a discount under an agreement made with a participating pharmacy.(b)  An entity described by Section 1652.003 may offer participation in a prescription drug discount program in connection with the solicitation of an application for issuance of a Medicare supplement benefit plan.(c)  An offer of participation in a prescription drug discount program described by this section is not a violation of Chapter 541 or any other law prohibiting the offer of rebates in the solicitation of insurance policies.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.075(a), eff. September 1, 2005.|
TX Ins Code § 1660.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter A. General Provisions|Section 1660.001. Findings and Purpose

Sec. 1660.001.  FINDINGS AND PURPOSE.  (a)  The legislature finds that patients deserve accurate, instantaneous information about coverage and financial responsibility to make well-informed decisions about their treatment and spending.(b)  The legislature finds that the ability of health benefit plan issuers and administrators to exchange eligibility and benefit information with physicians, health care providers, hospitals, and patients will ensure a more efficient and effective health care delivery system.(c)  The legislature finds that electronic access to eligibility information will reduce the amount of time and resources spent on administrative functions, prevent abuse and fraud, streamline and simplify processing of insurance claims, and increase transparency in premium cost and health care cost.(d)  The legislature finds that patients often request information about their health care coverage from their health care providers and that health care providers therefore need access to real-time information about their patients' eligibility to receive health care under the health benefit plan, coverage of health care under the health benefit plan, and the benefits associated with the health benefit plan.(e)  The legislature finds that adoption of technology by insurers, health maintenance organizations, and health care providers to facilitate use of electronic data exchange standards currently available will make coverage and health care electronic transactions more predictable, reliable, and consistent.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.|
TX Ins Code § 1660.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter A. General Provisions|Section 1660.002. Definitions

Sec. 1660.002.  DEFINITIONS.  In this chapter:(1)  "Administrator" has the meaning assigned by Section 4151.001.(2)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1147, Sec. 2.008(7), eff. September 1, 2011.(3)  "Enrollee" means an individual who is insured by or enrolled in a health benefit plan.(4)  "Health benefit plan" means an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an evidence of coverage that provides health insurance or health care benefits.(5)  "Transaction standards" means the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) transaction standards of the Centers for Medicare and Medicaid Services under 45 C.F.R. Part 162.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.008(7), eff. September 1, 2011.|
TX Ins Code § 1660.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter A. General Provisions|Section 1660.003. Applicability

Sec. 1660.003.  APPLICABILITY.  (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, 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 insurance 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)  This chapter does not apply to:(1)  a Medicaid managed care program operated under Chapter 533, Government Code;(2)  a Medicaid program operated under Chapter 32, Human Resources Code;(3)  the state child health plan or any similar plan operated under Chapter 62 or 63, Health and Safety Code; or(4)  a health benefit plan offered by an insurer or health maintenance organization that provides coverage only for dental services.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.|
TX Ins Code § 1660.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter A. General Provisions|Section 1660.004. General Rulemaking

Sec. 1660.004.  GENERAL RULEMAKING.  The commissioner may adopt rules as necessary to implement this chapter.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.003, eff. September 1, 2011.|
TX Ins Code § 1660.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter C. Identification Card Pilot Program|Section 1660.101. Pilot Program

Sec. 1660.101.  PILOT PROGRAM.  (a)  The commissioner shall designate a county or counties for initial participation in an identification card pilot program to begin not later than May 1, 2008.(b)  The commissioner shall require the issuer of a health benefit plan that is offered in the county or counties selected for initial participation in the identification card pilot program to issue identification cards that comply with commissioner rules to each enrollee of the plan.(c)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1147, Sec. 2.008(9), eff. September 1, 2011.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.008(9), eff. September 1, 2011.|
TX Ins Code § 1660.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter C. Identification Card Pilot Program|Section 1660.102. Pilot Program Rules

Sec. 1660.102.  PILOT PROGRAM RULES.  (a)  The commissioner shall adopt rules as necessary to implement the identification card pilot program, including the coordination of a testing phase and incorporation of changes identified in the testing phase.(b)  The commissioner may consider recommendations or any other information provided in response to a department-issued request for information relating to electronic data exchange, including identification card programs, before adopting rules regarding:(1)  information to be included on the identification cards;(2)  technology to be used to implement the identification card pilot program; and(3)  confidentiality and accuracy of the information required to be included on the identification cards.(c)  The commissioner shall consider the requirements of any federal program requiring health benefit plan issuers and administrators to provide point-of-service access to physicians and other health care providers regarding eligibility information before adopting rules to implement this section.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.Amended by: Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.004, eff. September 1, 2011.|
TX Ins Code § 1660.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter C. Identification Card Pilot Program|Section 1660.103. Requests for Information

Sec. 1660.103.  REQUESTS FOR INFORMATION.  The commissioner may issue requests for information as needed to implement the identification card pilot program under this subchapter.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.|
TX Ins Code § 1660.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1660 - Electronic Data Exchange|Subchapter C. Identification Card Pilot Program|Section 1660.104. Health Benefit Plan Issuer Compliance

Sec. 1660.104.  HEALTH BENEFIT PLAN ISSUER COMPLIANCE.  (a)  Each issuer of a health benefit plan that offers a health benefit plan in a county or counties designated by the commissioner under Section 1660.101 for initial participation in the identification card pilot program shall comply with this subchapter and rules adopted under this subchapter.(b)  To ensure timely compliance with the requirements of this subchapter, the commissioner may require the issuer of a health benefit plan to submit its procedures for implementation of the requirements to the department in the form prescribed by the commissioner.|Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.|
TX Ins Code § 1662.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter A. General Provisions|Section 1662.002. Definition of Accumulated Amounts

Sec. 1662.002.  DEFINITION OF ACCUMULATED AMOUNTS.  (a) In this chapter, "accumulated amounts" means:(1)  the amount of financial responsibility an enrollee has incurred at the time a request for cost-sharing information is made, with respect to a deductible or out-of-pocket limit; and(2)  to the extent a health benefit plan imposes a cumulative treatment limitation, including a limitation on the number of health care supplies, days, units, visits, or hours covered in a defined period, on a particular covered health care service or supply independent of individual medical necessity determinations, the amount that has accrued toward the limit on the health care service or supply.(b)  For an individual enrolled in coverage other than self-only coverage, the term includes the financial responsibility the individual has incurred toward meeting the individual's own deductible or out-of-pocket limit and the amount of financial responsibility that all individuals enrolled in the individual's coverage have incurred, in aggregate, toward meeting the plan's other than self-only deductible or out-of-pocket limit, as applicable.(c)  The term includes any expense that counts toward a deductible or out-of-pocket limit, including a copayment or coinsurance, but excludes any expense that does not count toward a deductible or out-of-pocket limit, including a premium payment, out-of-pocket expense for out-of-network health care services or supplies, or an amount for a health care service or supply not covered by the health benefit plan.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter A. General Provisions|Section 1662.003. Applicability of Chapter

Sec. 1662.003.  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, 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 health maintenance organization operating under Chapter 843;(4)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;(5)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;(6)  a stipulated premium company operating under Chapter 884;(7)  a fraternal benefit society operating under Chapter 885;(8)  a Lloyd's plan operating under Chapter 941; or(9)  an exchange operating under Chapter 942.(b)  Notwithstanding any other law, this chapter applies to:(1)  a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;(2)  a standard health benefit plan issued under Chapter 1507;(3)  a basic coverage plan under Chapter 1551;(4)  a basic plan under Chapter 1575;(5)  a primary care coverage plan under Chapter 1579;(6)  a plan providing basic coverage under Chapter 1601;(7)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and(8)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.(c)  This chapter does not apply to a health reimbursement arrangement or other account-based health benefit plan or a workers' compensation insurance policy.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter A. General Provisions|Section 1662.004. Rules

Sec. 1662.004.  RULES.  The commissioner may adopt rules necessary to implement this chapter.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.051. Required Disclosure to Enrollee on Request

Sec. 1662.051.  REQUIRED DISCLOSURE TO ENROLLEE ON REQUEST.  (a) On request of a health benefit plan enrollee, the health benefit plan issuer or administrator shall provide to the enrollee a disclosure in accordance with this subchapter.(b)  A health benefit plan issuer or administrator may allow an enrollee to request cost-sharing information for a specific preventive or non-preventive health care service or supply by including terms such as "preventive," "non-preventive," or "diagnostic" when requesting information under Subsection (a).|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1662.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle J - Health Information Technology and Availability|Chapter 1662 - Health Care Cost Transparency|Subchapter B. Required Disclosures to Enrollees|Section 1662.053. Method and Format for Disclosure

Sec. 1662.053.  METHOD AND FORMAT FOR DISCLOSURE.  A health benefit plan issuer or administrator shall provide the disclosure required under this subchapter through an Internet-based self-service tool described by Section 1662.054, a physical copy in accordance with Section 1662.055, or another means authorized by Section 1662.056.|Added by Acts 2021, 87th Leg., R.S., Ch. 333 (H.B. 2090), Sec. 3, eff. September 1, 2021.|