reglab/housing_qa huggingface dataset:
TX Ins Code § 1379.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter A. General Provisions|Section 1379.002. Applicability of Chapter

Sec. 1379.002.  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 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 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 applies to group health coverage made available by a school district in accordance with Section 22.004, Education Code.(c)  Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, this chapter applies to:(1)  a basic coverage plan under Chapter 1551;(2)  a basic plan under Chapter 1575;(3)  a primary care coverage plan under Chapter 1579; and(4)  basic coverage under Chapter 1601.(d)  Notwithstanding Section 1501.251 or any other law, this chapter applies to coverage under a small employer health benefit plan subject to Chapter 1501.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter A. General Provisions|Section 1379.003. Applicability to Certain Government Programs

Sec. 1379.003.  APPLICABILITY TO CERTAIN GOVERNMENT PROGRAMS.  To the extent allowed by federal law, the state Medicaid program, and a managed care organization that contracts with the Health and Human Services Commission to provide health care services to Medicaid recipients through a managed care plan, shall provide the benefits required under this chapter to a Medicaid recipient.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter A. General Provisions|Section 1379.004. Exception

Sec. 1379.004.  EXCEPTION.  This chapter does not apply to:(1)  a plan that provides coverage:(A)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(B)  as a supplement to a liability insurance policy;(C)  for credit insurance;(D)  for a specified disease or diseases;(E)  only for dental or vision care;(F)  only for hospital expenses; or(G)  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 a motor vehicle insurance policy; or(5)  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 1379.002.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter A. General Provisions|Section 1379.005. Rules

Sec. 1379.005.  RULES.  The commissioner, in accordance with Subchapter A, Chapter 36, may adopt rules to implement this chapter.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter B. Coverage for Routine Patient Care Costs|Section 1379.051. Routine Patient Care Costs

Sec. 1379.051.  ROUTINE PATIENT CARE COSTS.  For purposes of this chapter, routine patient care costs means the costs of any medically necessary health care service for which benefits are provided under a health benefit plan, without regard to whether the enrollee is participating in a clinical trial.  Routine patient care costs do not include:(1)  the cost of an investigational new drug or device that is not approved for any indication by the United States Food and Drug Administration, including a drug or device that is the subject of the clinical trial;(2)  the cost of a service that is not a health care service, regardless of whether the service is required in connection with participation in a clinical trial;(3)  the cost of a service that is clearly inconsistent with widely accepted and established standards of care for a particular diagnosis;(4)  a cost associated with managing a clinical trial; or(5)  the cost of a health care service that is specifically excluded from coverage under a health benefit plan.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter B. Coverage for Routine Patient Care Costs|Section 1379.052. Coverage Required

Sec. 1379.052.  COVERAGE REQUIRED.  A health benefit plan issuer shall provide benefits for routine patient care costs to an enrollee in connection with a phase I, phase II, phase III, or phase IV clinical trial if the clinical trial is conducted in relation to the prevention, detection, or treatment of a life-threatening disease or condition and is approved by:(1)  the Centers for Disease Control and Prevention of the United States Department of Health and Human Services;(2)  the National Institutes of Health;(3)  the United States Food and Drug Administration;(4)  the United States Department of Defense;(5)  the United States Department of Veterans Affairs; or(6)  an institutional review board of an institution in this state that has an agreement with the Office for Human Research Protections of the United States Department of Health and Human Services.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter B. Coverage for Routine Patient Care Costs|Section 1379.053. Research Institution

Sec. 1379.053.  RESEARCH INSTITUTION.  (a)  A health benefit plan issuer is not required to reimburse the research institution conducting the clinical trial for the cost of routine patient care provided through the research institution unless the research institution, and each health care professional providing routine patient care through the research institution, agrees to accept reimbursement under the health benefit plan, at the rates that are established under the plan, as payment in full for the routine patient care provided in connection with the clinical trial.(b)  A health benefit plan issuer is not required to provide benefits under this section for services that are a part of the subject matter of the clinical trial and that are customarily paid for by the research institution conducting the clinical trial.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter B. Coverage for Routine Patient Care Costs|Section 1379.054. Limitations on Coverage

Sec. 1379.054.  LIMITATIONS ON COVERAGE.  (a)  Notwithstanding Section 1379.053, this chapter does not require a health benefit plan issuer to provide benefits for routine patient care services provided outside of the plan's health care provider network unless out-of-network benefits are otherwise provided under the plan.(b)  This chapter does not require a health benefit plan issuer to provide benefits for health care services provided outside this state unless the health benefit plan otherwise provides benefits for health care services provided outside this state.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.055 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter B. Coverage for Routine Patient Care Costs|Section 1379.055. Deductible, Coinsurance, and Copayment Requirements

Sec. 1379.055.  DEDUCTIBLE, COINSURANCE, AND COPAYMENT REQUIREMENTS.  The benefits required under this chapter may be made subject to a deductible, coinsurance, or copayment requirement comparable to other deductible, coinsurance, or copayment requirements applicable under the health benefit plan.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1379.056 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1379 - Coverage for Routine Patient Care Costs for Enrollees Participating in Certain Clinical Trials|Subchapter B. Coverage for Routine Patient Care Costs|Section 1379.056. Cancellation or Nonrenewal Prohibited

Sec. 1379.056.  CANCELLATION OR NONRENEWAL PROHIBITED.  The issuer of a health benefit plan may not cancel or refuse to renew coverage under a plan solely because an enrollee in the plan participates in a clinical trial described by Section 1379.052.|Added by Acts 2009, 81st Leg., R.S., Ch. 719 (S.B. 39), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1425.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1425 - Application of Subtitle to Certain Coverage|Subchapter A. Excepted Benefits|Section 1425.001. Exemption From Application of Subtitle

Sec. 1425.001.  EXEMPTION FROM APPLICATION OF SUBTITLE.  (a)  Except as provided by Section 1425.002, a provision of this subtitle that becomes effective on or after January 2, 2010, does not apply to:(1)  a plan that provides coverage only:(A)  for a specified disease or diseases or under an individual limited benefit policy;(B)  for accidental death or dismemberment;(C)  as a supplement to a liability insurance policy; or(D)  for dental or vision care;(2)  disability income insurance coverage or a combination of accident-only and disability income insurance coverage;(3)  credit insurance coverage;(4)  a hospital confinement indemnity policy;(5)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);(6)  a workers' compensation insurance policy;(7)  medical payment insurance coverage provided under a motor vehicle insurance policy;(8)  a long-term care insurance policy, including a nursing home fixed indemnity policy, except as provided by Subsection (b); or(9)  an occupational accident policy.(b)  A long-term care insurance policy, including a nursing home fixed indemnity policy, is subject to this subtitle if the commissioner determines that the policy provides benefits so comprehensive that it is a health benefit plan and should not be subject to the exemption provided under this section.|Added by Acts 2009, 81st Leg., R.S., Ch. 228 (S.B. 1479), Sec. 1, eff. May 27, 2009.|
TX Ins Code § 1425.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1425 - Application of Subtitle to Certain Coverage|Subchapter A. Excepted Benefits|Section 1425.002. Specific Language Controls

Sec. 1425.002.  SPECIFIC LANGUAGE CONTROLS.  A provision of this subtitle that becomes effective on or after January 2, 2010, and that requires coverage or the offer of coverage of a health care service or benefit applies to a plan or policy described by Section 1425.001(a) only to the extent expressly and specifically provided by law.|Added by Acts 2009, 81st Leg., R.S., Ch. 228 (S.B. 1479), Sec. 1, eff. May 27, 2009.|
TX Ins Code § 1425.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1425 - Application of Subtitle to Certain Coverage|Subchapter B. Benefits Requiring Defrayal|Section 1425.051. Definition

Sec. 1425.051.  DEFINITION.  In this subchapter, "qualified health plan" has the meaning assigned by 45 C.F.R. Section 155.20. |Added by Acts 2021, 87th Leg., R.S., Ch. 890 (S.B. 2016), Sec. 3, eff. June 16, 2021.|
TX Ins Code § 1425.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1425 - Application of Subtitle to Certain Coverage|Subchapter B. Benefits Requiring Defrayal|Section 1425.052. Exemption From Subtitle for Benefits Requiring Defrayal

Sec. 1425.052.  EXEMPTION FROM SUBTITLE FOR BENEFITS REQUIRING DEFRAYAL.  (a)  A provision of this subtitle that is enacted on or after January 1, 2012, does not apply to a qualified health plan if a determination is made under 45 C.F.R. Section 155.170 that:(1)  the provision requires the qualified health plan to offer benefits in addition to the essential health benefits required under 42 U.S.C. Section 18022(b); and(2)  this state must make payments to defray the cost of the additional benefits mandated by the provision.(b)  If a determination described by Subsection (a) is made as to a qualified health plan, the provision to which the determination relates does not apply to a non-qualified health plan if the non-qualified health plan is offered in the same market as the qualified health plan.|Added by Acts 2021, 87th Leg., R.S., Ch. 890 (S.B. 2016), Sec. 3, eff. June 16, 2021.|
TX Ins Code § 1451.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter B. Designation of Practitioners Under Accident and Health Insurance Policy|Section 1451.051. Applicability of Subchapter

Sec. 1451.051.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies to an accident and health insurance policy, including an individual, blanket, or group policy.(b)  This subchapter applies to an accident and health insurance policy issued by a stipulated premium company subject to Chapter 884.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter B. Designation of Practitioners Under Accident and Health Insurance Policy|Section 1451.052. Applicability of General Provisions of Other Law

Sec. 1451.052.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW.  The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, the construction of policies under that chapter, rulemaking under that chapter, and definitions of terms applicable in that chapter, apply to this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter B. Designation of Practitioners Under Accident and Health Insurance Policy|Section 1451.053. Practitioner Designation

Sec. 1451.053.  PRACTITIONER DESIGNATION.  (a)  An accident and health insurance policy may not make a benefit contingent on treatment or examination by one or more particular health care practitioners listed in Section 1451.001 unless the policy contains a provision that designates the practitioners whom the insurer will and will not recognize.(b)  The insurer may include the provision anywhere in the policy or in an endorsement attached to the policy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter B. Designation of Practitioners Under Accident and Health Insurance Policy|Section 1451.054. Terms Used to Designate Health Care Practitioners

Sec. 1451.054.  TERMS USED TO DESIGNATE HEALTH CARE PRACTITIONERS.  A provision of an accident and health insurance policy that designates the health care practitioners whom the insurer will and will not recognize must use the terms defined by Section 1451.001 with the meanings assigned by that section.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter C. Selection of Practitioners|Section 1451.101. Definitions

Sec. 1451.101.  DEFINITIONS.  In this subchapter:(1)  "Health insurance policy" means a policy, contract, or agreement described by Section 1451.102.(2)  "Insured" means an individual who is issued, is a party to, or is a beneficiary under a health insurance policy.(3)  "Insurer" means an insurer, association, or organization described by Section 1451.102.(4)  "Nurse first assistant" has the meaning assigned by Section 301.1525, Occupations Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter C. Selection of Practitioners|Section 1451.102. Applicability of Subchapter

Sec. 1451.102.  APPLICABILITY OF SUBCHAPTER.  Except as provided by this subchapter, this subchapter applies only to an individual, group, blanket, or franchise insurance policy, insurance agreement, or group hospital service contract that provides health benefits, accident benefits, or health and accident benefits for medical or surgical expenses incurred as a result of an accident or sickness and that is delivered, issued for delivery, or renewed in this state by any incorporated or unincorporated insurance company, association, or organization, including:(1)  a fraternal benefit society operating under Chapter 885;(2)  a general casualty company operating under Chapter 861;(3)  a life, health, and accident insurance company operating under Chapter 841 or 982;(4)  a Lloyd's plan operating under Chapter 941;(5)  a local mutual aid association operating under Chapter 886;(6)  a mutual insurance company writing insurance other than life insurance operating under Chapter 883;(7)  a mutual life insurance company operating under Chapter 882;(8)  a reciprocal exchange operating under Chapter 942;(9)  a statewide mutual assessment company, mutual assessment company, or mutual assessment life, health, and accident association operating under Chapter 881 or 887;  and(10)  a stipulated premium company operating under Chapter 884.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter C. Selection of Practitioners|Section 1451.103. Conflicting Provisions Void

Sec. 1451.103.  CONFLICTING PROVISIONS VOID.  (a)  A provision of a health insurance policy that conflicts with this subchapter is void to the extent of the conflict.(b)  The presence in a health insurance policy of a provision void under Subsection (a) does not affect the validity of other policy provisions.(c)  An insurer shall bring each approved policy form that contains a provision that conflicts with this subchapter into compliance with this subchapter by use of:(1)  a rider or endorsement approved by the commissioner;  or(2)  a new or revised policy form approved by the commissioner.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter C. Selection of Practitioners|Section 1451.104. Nondiscriminatory Payment or Reimbursement; Exception

Sec. 1451.104.  NONDISCRIMINATORY PAYMENT OR REIMBURSEMENT;  EXCEPTION.  (a)  An insurer may not classify, differentiate, or discriminate between scheduled services or procedures provided by a health care practitioner selected under this subchapter and performed in the scope of that practitioner's license and the same services or procedures provided by another type of health care practitioner whose services or procedures are covered by a health insurance policy, in regard to:(1)  the payment schedule or payment provisions of the policy;  or(2)  the amount or manner of payment or reimbursement under the policy.(b)  An insurer may not deny payment or reimbursement for services or procedures in accordance with the policy payment schedule or payment provisions solely because the services or procedures were performed by a health care practitioner selected under this subchapter.(c)  Notwithstanding Subsection (a), a health insurance policy may provide for a different amount of payment or reimbursement for scheduled services or procedures performed by an advanced practice nurse, nurse first assistant, licensed surgical assistant, or physician assistant if the methodology used to compute the amount is the same as the methodology used to compute the amount of payment or reimbursement when the services or procedures are provided by a physician.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|