reglab/housing_qa huggingface dataset:
TX Ins Code § 1651.105 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1651 - Long-Term Care Benefit Plans|Subchapter C. Partnership for Long-Term Care Program|Section 1651.105. Required Training

Sec. 1651.105.  REQUIRED TRAINING.  (a)  Each individual who sells a long-term care benefit plan under the partnership for long-term care program must complete training and demonstrate evidence of an understanding of these plans and how the plans relate to other public and private coverage of long-term care.(b)  Each long-term care benefit plan issuer that offers a plan under the partnership for long-term care program shall certify to the commissioner, in the form required by the commissioner, that each individual who sells the plan on behalf of the issuer complies with the requirements of this section.|Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.|
TX Ins Code § 1651.106 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1651 - Long-Term Care Benefit Plans|Subchapter C. Partnership for Long-Term Care Program|Section 1651.106. Effect of Discontinuation of Program on Policy

Sec. 1651.106.  EFFECT OF DISCONTINUATION OF PROGRAM ON POLICY.  If the partnership for long-term care program is discontinued, an individual who purchased an approved plan before the date the program is discontinued remains eligible to receive dollar-for-dollar asset disregard and asset protection under the medical assistance program.|Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.|
TX Ins Code § 1651.107 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle I - Specialized Coverages|Chapter 1651 - Long-Term Care Benefit Plans|Subchapter C. Partnership for Long-Term Care Program|Section 1651.107. Rules

Sec. 1651.107.  RULES.  The commissioner may adopt rules as necessary to implement this subchapter.|Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.|
TX Ins Code § 1652.001 (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 A. General Provisions|Section 1652.001. Definitions

Sec. 1652.001.  DEFINITIONS.  In this chapter:(1)  "Applicant" means:(A)  an individual who seeks to contract for insurance or other health benefits under an individual Medicare supplement benefit plan;  or(B)  the proposed certificate holder of a group Medicare supplement benefit plan.(2)  "Approved regulatory program" means a state regulatory program that complies with the requirements of Section 1882, Social Security Act (42 U.S.C. Section 1395ss).(3)  "Medicare" means the Health Insurance for the Aged Act (42 U.S.C. Section 1395 et seq.), as amended.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.002 (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 A. General Provisions|Section 1652.002. Medicare Supplement Benefit Plan

Sec. 1652.002.  MEDICARE SUPPLEMENT BENEFIT PLAN.  (a)  "Medicare supplement benefit plan" means a group or individual policy of accident and health insurance, a subscriber contract of a group hospital service corporation operating under Chapter 842, or, to the extent required by federal law, an evidence of coverage issued by a health maintenance organization operating under Chapter 843 that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of an individual eligible for Medicare.(b)  A policy, contract, subscriber contract, or evidence of coverage is not considered to be a Medicare supplement benefit plan if it is:(1)  a policy, contract, subscriber contract, or evidence of coverage of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or a combination, for employees or former employees, or a combination, or for members or former members, or a combination, of the labor organizations;(2)  a policy or health care benefit plan, including a policy or contract of group insurance, a group contract of a group hospital service corporation operating under Chapter 842, or a group evidence of coverage issued by a health maintenance organization operating under Chapter 843 that is not marketed or held to be a Medicare supplement benefit plan;  or(3)  an individual or group evidence of coverage issued in accordance with a contract under Section 1833 or 1876, Social Security Act (42 U.S.C. Section 1395l or 1395mm), by a health maintenance organization operating under Chapter 843.(c)  The commissioner by rule may modify the definition of "Medicare supplement benefit plan" provided by Subsection (a) to the extent necessary for this state to qualify 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 § 1652.003 (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 A. General Provisions|Section 1652.003. Applicability of Chapter

Sec. 1652.003.  APPLICABILITY OF CHAPTER.  This chapter applies to an individual or group Medicare supplement benefit plan delivered or issued for delivery in this state and, regardless of the place where the plan was delivered or issued for delivery, a certificate that was issued under a group Medicare supplement benefit plan and delivered or issued for delivery in this state, if the plan or certificate is issued by:(1)  a capital stock insurance company, including a life, health and accident, and general casualty insurance company;(2)  a mutual life insurance company;(3)  a mutual assessment life insurance company, including a statewide mutual assessment company, local mutual aid association, and burial association;(4)  a mutual or mutual assessment association of any kind, including an association subject to Section 887.102;(5)  a mutual insurance company other than a life insurance company;(6)  a mutual or natural premium life or casualty insurance company;(7)  a fraternal benefit society;(8)  a Lloyd's plan;(9)  a reciprocal or interinsurance exchange;(10)  a nonprofit hospital, medical, or dental service corporation, including a corporation operating under Chapter 842;(11)  a stipulated premium company;(12)  another insurer that by law is required to be authorized by the department;  or(13)  a health maintenance organization operating under Chapter 843, to the extent required by federal law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.004 (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 A. General Provisions|Section 1652.004. Construction of Chapter

Sec. 1652.004.  CONSTRUCTION OF CHAPTER.  (a)  This chapter may not be construed to enlarge the powers of an entity described by Section 1652.003.(b)  This chapter controls to the extent of any conflict with another provision of this code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.005 (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 A. General Provisions|Section 1652.005. Rules Necessary for Certification

Sec. 1652.005.  RULES NECESSARY FOR CERTIFICATION.  In addition to other rules required or authorized by this chapter, the commissioner shall adopt reasonable rules necessary and proper to carry out this chapter, including rules adopted in accordance with federal law relating to the regulation of Medicare supplement benefit plan coverage that are 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 § 1652.051 (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 B. Benefits|Section 1652.051. Minimum Standards

Sec. 1652.051.  MINIMUM STANDARDS.  (a)  The commissioner shall adopt reasonable rules to establish specific standards for provisions in Medicare supplement benefit plans and standards for facilitating comparisons of different Medicare supplement benefit plans.  The standards are in addition to and must be in accordance with:(1)  applicable laws of this state, including Chapters 842 and 1201;(2)  applicable federal law, rules, regulations, and standards;  and(3)  any model rules and regulations required by federal law, including Section 1882, Social Security Act (42 U.S.C. Section 1395ss).(b)  The standards may include provisions relating to:(1)  terms of renewability;(2)  initial and subsequent conditions of eligibility;(3)  nonduplication of coverage;(4)  probationary periods;(5)  benefit limitations, exceptions, and reductions;(6)  elimination periods;(7)  requirements for replacement;(8)  recurrent conditions;(9)  definitions of terms;  and(10)  exclusions required by state or federal law.(c)  The commissioner may adopt reasonable rules that specifically prohibit benefit plan provisions that:(1)  are not otherwise specifically authorized by statute;  and(2)  the commissioner determines are unjust, unfair, or unfairly discriminatory to a person who is covered or proposed for coverage.(d)  Rules adopted under this section must include requirements that are at least equal to those required by federal law, rules, regulations, and standards, including Section 1882, Social Security Act (42 U.S.C. Section 1395ss).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.052 (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 B. Benefits|Section 1652.052. Minimum Standards for Benefits and Claim Payments

Sec. 1652.052.  MINIMUM STANDARDS FOR BENEFITS AND CLAIM PAYMENTS.  (a)  The commissioner shall adopt reasonable rules to establish minimum standards for benefits and claim payments under Medicare supplement benefit plans.(b)  The standards for benefits and claim payments must include the requirements for certification of Medicare supplement benefit plans prescribed by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.053 (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 B. Benefits|Section 1652.053. Duplicate Benefits Prohibited

Sec. 1652.053.  DUPLICATE BENEFITS PROHIBITED.  A Medicare supplement benefit plan or certificate in force in this state may not contain benefits that duplicate benefits provided by Medicare.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.054 (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 B. Benefits|Section 1652.054. Basic Plan

Sec. 1652.054.  BASIC PLAN.  An entity described by Section 1652.003 that offers for sale in this state a Medicare supplement benefit plan must offer a basic Medicare supplement benefit plan that:(1)  provides only those benefits common to all Medicare supplement benefit plans;  and(2)  meets but does not exceed the minimum standards of benefits for Medicare supplement benefit plans adopted by the commissioner and authorized by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.055 (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 B. Benefits|Section 1652.055. Additional Benefits

Sec. 1652.055.  ADDITIONAL BENEFITS.  (a)  In addition to the basic Medicare supplement benefit plan described by Section 1652.054, an entity may offer additional Medicare supplement benefit plans for sale in this state.(b)  The combination of benefits provided by an additional plan must conform to one of the benefit packages adopted by the commissioner and authorized by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).(c)  The commissioner by rule shall provide for the approval of new or innovative benefits that may be provided in a plan other than the basic plan and that otherwise comply with this subchapter.  The benefits must:(1)  be offered in a manner consistent with the goal of Medicare supplement benefit plan simplification;  and(2)  meet the requirements prescribed by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.056 (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 B. Benefits|Section 1652.056. Coverage for Mammography

Sec. 1652.056.  COVERAGE FOR MAMMOGRAPHY.  (a)  In this section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast.(b)  Each Medicare supplement benefit plan must include coverage for an annual screening by low-dose mammography for the presence of occult breast cancer.(c)  The coverage for the annual screening may not be less favorable than coverage for other radiological examinations and must be subject to the same dollar limits, deductibles, and coinsurance factors.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.057 (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 B. Benefits|Section 1652.057. Waiver of Waiting Period

Sec. 1652.057.  WAIVER OF WAITING PERIOD.  (a)  An entity that delivers or issues for delivery in this state a Medicare supplement benefit plan or certificate that replaces a Medicare supplement benefit plan or certificate shall give credit for the satisfaction or partial satisfaction of any waiting period, elimination period, or probationary period for a preexisting condition that has been satisfied under the plan being replaced.(b)  A replacement plan that clearly provides a new or additional benefit may include appropriate and clearly stated periods as a condition for payment of the new or additional benefit.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.058 (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 B. Benefits|Section 1652.058. Coverage for Preexisting Condition

Sec. 1652.058.  COVERAGE FOR PREEXISTING CONDITION.  (a)  A Medicare supplement benefit plan may not contain a provision that excludes coverage for a claim for losses incurred more than six months after the effective date of coverage for a preexisting condition.(b)  A Medicare supplement benefit plan may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.101 (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 C. Loss Ratio Standards|Section 1652.101. Loss Ratio Standards

Sec. 1652.101.  LOSS RATIO STANDARDS.  (a)  A Medicare supplement benefit plan must return to a plan holder benefits that are reasonable in relation to the premium charged.(b)  The commissioner shall adopt reasonable rules to establish minimum loss ratio standards for Medicare supplement benefit plans.  The standards must be established:(1)  on the basis of incurred claims experience and earned premiums for the entire period for which rates are computed to provide coverage;(2)  in accordance with accepted actuarial principles and practices;  and(3)  to the extent necessary for the 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 § 1652.102 (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 C. Loss Ratio Standards|Section 1652.102. Filing Requirements

Sec. 1652.102.  FILING REQUIREMENTS.  (a)  Annually, each entity providing Medicare supplement benefit plans in this state shall file with the department the entity's rates, rating schedule, and supporting documentation demonstrating that:(1)  the entity is complying with the applicable loss ratio standards of this state;  and(2)  the actual and expected losses in relation to premiums comply with the requirements of this subchapter and the rules adopted by the commissioner.(b)  The documentation required by Subsection (a) must include a report of the ratio of incurred losses to covered premiums for the preceding calendar year, illustrated by calendar year of issue.(c)  The commissioner may adopt rules relating to filing requirements for rates, rating schedules, and loss ratios.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.103 (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 C. Loss Ratio Standards|Section 1652.103. Review of Premium Increases

Sec. 1652.103.  REVIEW OF PREMIUM INCREASES.  (a)  The commissioner by rule shall provide a process for reviewing and approving or disapproving a proposed premium increase relating to a Medicare supplement benefit plan.(b)  The rules must comply with federal law, including Section 1882, Social Security Act (42 U.S.C. Section 1395ss).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.104 (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 C. Loss Ratio Standards|Section 1652.104. Benefit Changes

Sec. 1652.104.  BENEFIT CHANGES.  (a)  Before the date on which a Medicare benefit change required by federal law takes effect, each entity providing in this state a Medicare supplement benefit plan existing on the effective date of the change shall file with the commissioner, in accordance with Chapter 1701:(1)  each appropriate premium adjustment necessary to produce the loss ratios originally anticipated for the applicable plan, accompanied by any supporting documents necessary to justify the adjustment;  and(2)  each appropriate rider, endorsement, or plan form necessary to modify the coverage so as to eliminate benefit duplications with Medicare.(b)  A rider, endorsement, or plan form required by Subsection (a) must provide a clear description of the Medicare supplement benefits provided by the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.105 (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 C. Loss Ratio Standards|Section 1652.105. Reporting Loss Ratio Information to Secretary of Health and Human Services

Sec. 1652.105.  REPORTING LOSS RATIO INFORMATION TO SECRETARY OF HEALTH AND HUMAN SERVICES.  To the extent necessary for this state to obtain or retain certification as a state with an approved regulatory program, the department shall comply with federal requirements relating to periodic reporting of loss ratio information to the secretary of health and human services, based on a uniform methodology, as authorized by federal law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.151 (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 1652.151. Rules Relating to Disclosure

Sec. 1652.151.  RULES RELATING TO DISCLOSURE.  The rules adopted under Sections 1652.152, 1652.153, and 1652.154 must include provisions and requirements that are at least equal to those required by federal law, including the rules, regulations, and standards adopted under Section 1882, Social Security Act (42 U.S.C. Section 1395ss).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.152 (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 1652.152. Outline of Coverage

Sec. 1652.152.  OUTLINE OF COVERAGE.  (a)  To provide for full and fair disclosure in the sale of Medicare supplement benefit plans, a Medicare supplement benefit plan or certificate may not be delivered or issued for delivery in this state unless an outline of coverage that complies with this section is delivered to the applicant when the applicant applies for the coverage.(b)  The commissioner by rule shall prescribe the format and content of the outline of coverage required by Subsection (a).  The rules must address the style, arrangement, and overall appearance of the outline of coverage, including the size, color, and prominence of type and the arrangement of text and captions.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|
TX Ins Code § 1652.153 (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 1652.153. Informational Brochure

Sec. 1652.153.  INFORMATIONAL BROCHURE.  (a)  The commissioner by rule may prescribe a standard form and the contents of an informational brochure intended to improve the ability of an individual eligible for Medicare to understand Medicare and to select the most appropriate Medicare supplement coverage.(b)  Except as provided by Subsection (c), the commissioner by rule may require that the informational brochure be provided to an individual eligible for Medicare concurrently with delivery of the outline of coverage.(c)  If the plan is a direct response Medicare supplement benefit plan, the commissioner by rule may require that the informational brochure be provided on request to an individual eligible for Medicare at any time not later than the time the plan is delivered.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.|