reglab/housing_qa huggingface dataset:
TX Ins Code § 1370.002 (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 1370.002. Exceptions

Sec. 1370.002.  EXCEPTIONS.  (a) This chapter does not apply to:(1)  a plan that provides coverage:(A)  only for benefits for a specified disease or for another limited benefit, other than a plan that provides benefits for cancer treatment or similar services;(B)  only for accidental death or dismemberment;(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(D)  as a supplement to a liability insurance policy;(E)  only for dental or vision care; or(F)  only for indemnity for hospital confinement;(2)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);(3)  a workers' compensation insurance policy;(4)  medical payment insurance coverage provided under an automobile insurance policy;(5)  a credit insurance policy;(6)  a limited benefit policy that does not provide coverage for physical examinations or wellness exams; or(7)  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 1370.001.(b)  To the extent that providing coverage for ovarian cancer screening under this chapter would otherwise require this state to make a payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 C.F.R. Section 155.20, is not required to provide a benefit for the ovarian cancer screening under this chapter that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).|Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 176 (H.B. 2813), Sec. 2, eff. September 1, 2015.|
TX Ins Code § 1370.003 (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 1370.003. Coverage Required

Sec. 1370.003.  COVERAGE REQUIRED.  (a)  A health benefit plan that provides coverage for diagnostic medical procedures must provide to each woman 18 years of age or older enrolled in the plan coverage for expenses for an annual medically recognized diagnostic examination for the early detection of ovarian cancer and cervical cancer.(b)  Coverage required under this section includes at a minimum:(1)  a CA 125 blood test;(2)  a conventional Pap smear screening or a screening using liquid-based cytology methods, as approved by the United States Food and Drug Administration, alone or in combination with a test approved by the United States Food and Drug Administration for the detection of the human papillomavirus; and(3)  any other test or screening approved by the United States Food and Drug Administration for the detection of ovarian cancer.(c)  A screening test required under this section must be performed in accordance with the guidelines adopted by:(1)  the American College of Obstetricians and Gynecologists; or(2)  another similar national organization of medical professionals recognized by the commissioner.|Added by Acts 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 176 (H.B. 2813), Sec. 3, eff. September 1, 2015.Acts 2021, 87th Leg., R.S., Ch. 312 (H.B. 428), Sec. 1, eff. September 1, 2021.|
TX Ins Code § 1370.004 (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 1370.004. Notice of Coverage

Sec. 1370.004.  NOTICE OF COVERAGE.  (a)  A health benefit plan issuer shall provide to each woman 18 years of age or older 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 2005, 79th Leg., Ch. 577 (H.B. 1485), Sec. 1, eff. September 1, 2005.|
TX Ins Code § 1371.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1371 - Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related Services|Section 1371.001. Definitions

Sec. 1371.001.  DEFINITIONS.  In this chapter:(1)  "Enrollee" means an individual entitled to coverage under a health benefit plan.(2)  "Orthotic device" means a custom-fitted or custom-fabricated medical device that is applied to a part of the human body to correct a deformity, improve function, or relieve symptoms of a disease.(3)  "Prosthetic device" means an artificial device designed to replace, wholly or partly, an arm or leg.|Added by Acts 2009, 81st Leg., R.S., Ch. 30 (H.B. 806), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1371.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1371 - Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related Services|Section 1371.002. Applicability of Chapter

Sec. 1371.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage provided by a health group cooperative under Subchapter B of that chapter, that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a fraternal benefit society operating under Chapter 885;(4)  a stipulated premium company operating under Chapter 884;(5)  a reciprocal exchange operating under Chapter 942;(6)  a Lloyd's plan operating under Chapter 941;(7)  a health maintenance organization operating under Chapter 843;(8)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or(9)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.(b)  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.|Added by Acts 2009, 81st Leg., R.S., Ch. 30 (H.B. 806), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1371.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1371 - Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related Services|Section 1371.003. Required Coverage for Prosthetic Devices, Orthotic Devices, and Related Services

Sec. 1371.003.  REQUIRED COVERAGE FOR PROSTHETIC DEVICES, ORTHOTIC DEVICES, AND RELATED SERVICES.  (a)  A health benefit plan must provide coverage for prosthetic devices, orthotic devices, and professional services related to the fitting and use of those devices that equals the coverage provided under federal laws for health insurance for the aged and disabled under Sections 1832, 1833, and 1834, Social Security Act (42 U.S.C. Sections 1395k, 1395l, and 1395m), and 42 C.F.R. Sections 410.100, 414.202, 414.210, and 414.228, as applicable.(b)  Covered benefits under this chapter are limited to the most appropriate model of prosthetic device or orthotic device that adequately meets the medical needs of the enrollee as determined by the  enrollee's treating physician or podiatrist and prosthetist or orthotist, as applicable.(c)  Subject to applicable copayments and deductibles, the repair and replacement of a prosthetic device or orthotic device is a covered benefit under this chapter unless the repair or replacement is necessitated by misuse or loss by the enrollee.(d)  Coverage required under this section:(1)  must be provided in a manner determined to be appropriate in consultation with the treating physician or podiatrist and prosthetist or orthotist, as applicable, and the enrollee;(2)  may be subject to annual deductibles, copayments, and coinsurance that are consistent with annual deductibles, copayments, and coinsurance required for other coverage under the health benefit plan;  and(3)  may not be subject to annual dollar limits.(e)  Covered benefits under this chapter may be provided by a pharmacy that has employees who are qualified under the Medicare system and applicable Medicaid regulations to service and bill for orthotic services.  This chapter does not preclude a pharmacy from being reimbursed by a health benefit plan for the provision of orthotic services.|Added by Acts 2009, 81st Leg., R.S., Ch. 30 (H.B. 806), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1371.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1371 - Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related Services|Section 1371.004. Preauthorization

Sec. 1371.004.  PREAUTHORIZATION.  A health benefit plan may require prior authorization for a prosthetic device or an orthotic device in the same manner that the health benefit plan requires prior authorization for any other covered benefit.|Added by Acts 2009, 81st Leg., R.S., Ch. 30 (H.B. 806), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1371.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1371 - Coverage for Certain Prosthetic Devices, Orthotic Devices, and Related Services|Section 1371.005. Managed Care Plan

Sec. 1371.005.  MANAGED CARE PLAN.  A health benefit plan provider may require that, if coverage is provided through a managed care plan, the benefits mandated under this chapter are covered benefits only if the prosthetic devices or orthotic devices are provided by a vendor or a provider, and related services are rendered by a provider, that contracts with or is designated by the health benefit plan provider.  If the health benefit plan provider provides in-network and out-of-network services, the coverage for prosthetic devices or orthotic devices provided through out-of-network services must be comparable to that provided through in-network services.|Added by Acts 2009, 81st Leg., R.S., Ch. 30 (H.B. 806), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1376.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1376 - Certain Tests for Early Detection of Cardiovascular Disease|Section 1376.001. Applicability of Chapter

Sec. 1376.001.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan 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; or(vi)  a health maintenance organization operating under Chapter 843;(B)  a health benefit plan that is offered by a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;(C)  a small employer health benefit plan written under Chapter 1501; or(D)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); or(2)  is offered by an approved nonprofit health corporation operating under Chapter 844.(b)  Notwithstanding any provision in Chapter 1601 or any other law, this chapter applies to basic coverage under Chapter 1601.|Added by Acts 2009, 81st Leg., R.S., Ch. 1270 (H.B. 1290), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1376.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1376 - Certain Tests for Early Detection of Cardiovascular Disease|Section 1376.002. Exceptions

Sec. 1376.002.  EXCEPTIONS.  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; or(E)  only for indemnity for hospital confinement;(2)  a standard health benefit plan issued under Chapter 1507;(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 1376.001.|Added by Acts 2009, 81st Leg., R.S., Ch. 1270 (H.B. 1290), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1376.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1376 - Certain Tests for Early Detection of Cardiovascular Disease|Section 1376.003. Minimum Coverage Required

Sec. 1376.003.  MINIMUM COVERAGE REQUIRED.  (a)  A health benefit plan that provides coverage for screening medical procedures must provide the minimum coverage required by this section to each covered individual:(1)  who is:(A)  a male older than 45 years of age and younger than 76 years of age; or(B)  a female older than 55 years of age and younger than 76 years of age; and(2)  who:(A)  is diabetic; or(B)  has a risk of developing coronary heart disease, based on a score derived using the Framingham Heart Study coronary prediction algorithm, that is intermediate or higher.(b)  The minimum coverage required to be provided under this section is coverage of up to $200 for one of the following noninvasive screening tests for atherosclerosis and abnormal artery structure and function every five years, performed by a laboratory that is certified by a national organization recognized by the commissioner by rule for the purposes of this section:(1)  computed tomography (CT) scanning measuring coronary artery calcification; or(2)  ultrasonography measuring carotid intima-media thickness and plaque.|Added by Acts 2009, 81st Leg., R.S., Ch. 1270 (H.B. 1290), Sec. 1, eff. September 1, 2009.|
TX Ins Code § 1453.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1453 - Disclosure of Reimbursement Guidelines Under Managed Care Plan|Section 1453.001. Definitions

Sec. 1453.001.  DEFINITIONS.  In this chapter:(1)  "Health care provider" means:(A)  a hospital, emergency clinic, outpatient clinic, or other facility providing health care services;  or(B)  an individual who is licensed in this state to provide health care services.(2)  "Managed care entity" means:(A)  a health maintenance organization;(B)  a preferred provider benefit plan issuer;(C)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;  or(D)  another entity that offers a managed care plan, including:(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 stipulated premium company operating under Chapter 884;(v)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;  and(vi)  an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis.(3)  "Managed care plan" means a health benefit plan:(A)  under which health care services are provided through contracts with health care providers to individuals enrolled in or insured under the plan;  and(B)  that provides financial incentives to individuals enrolled in or insured under the plan to use health care providers participating in the plan and procedures covered by the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1453.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1453 - Disclosure of Reimbursement Guidelines Under Managed Care Plan|Section 1453.002. Provision of Information Regarding Reimbursement Guidelines

Sec. 1453.002.  PROVISION OF INFORMATION REGARDING REIMBURSEMENT GUIDELINES.  (a)  On the written request of an out-of-network health care provider, a managed care entity shall furnish to the provider a written description of the factors considered by the entity in determining the amount of reimbursement the provider may receive for goods or services provided to an individual enrolled in or insured under the entity's managed care plan.(b)  This section does not require a managed care entity to disclose proprietary information that is prohibited from disclosure by a contract between the entity and a vendor that supplies payment or statistical data to the entity.(c)  A contract between a managed care entity and a vendor that supplies payment or statistical data to the entity may not prohibit the entity from disclosing under this section:(1)  the name of the vendor;  or(2)  the methodology and origin of information used to determine the amount of reimbursement.(d)  A managed care entity that denies a request for information described by Subsection (b) shall send a copy of the request and the information requested to the department for review.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1453.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1453 - Disclosure of Reimbursement Guidelines Under Managed Care Plan|Section 1453.003. Rules

Sec. 1453.003.  RULES.  The commissioner shall adopt rules as necessary to implement this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1455.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1455 - Telemedicine, Teledentistry, and Telehealth|Section 1455.001. Definitions

Sec. 1455.001.  DEFINITIONS.  In this chapter:(1)  "Dentist" means a person licensed to practice dentistry in this state under Subtitle D, Title 3, Occupations Code.(1-a)  "Health professional" means:(A)  a physician;(B)  an individual who is:(i)  licensed or certified in this state to perform health care services; and(ii)  authorized to assist:(a)  a physician in providing telemedicine medical services that are delegated and supervised by the physician; or(b)  a dentist in providing teledentistry dental services that are delegated and supervised by the dentist;(C)  a licensed or certified health professional acting within the scope of the license or certification who does not perform a telemedicine medical service or a teledentistry dental service; or(D)  a dentist.(2)  "Physician" means a person licensed to practice medicine in this state under Subtitle B, Title 3, Occupations Code.(2-a) "Platform" means the technology, system, software, application, modality, or other method through which a health professional remotely interfaces with a patient when providing a health care service or procedure as a telemedicine medical service or telehealth service. (3)  "Teledentistry dental service," "telehealth service," and "telemedicine medical service" have the meanings assigned by Section 111.001, Occupations Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2017, 85th Leg., R.S., Ch. 205 (S.B. 1107), Sec. 5, eff. January 1, 2018.Acts 2019, 86th Leg., R.S., Ch. 1174 (H.B. 3345), Sec. 1, eff. September 1, 2019.Acts 2021, 87th Leg., R.S., Ch. 811 (H.B. 2056), Sec. 26, eff. September 1, 2021.|
TX Ins Code § 1455.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1455 - Telemedicine, Teledentistry, and Telehealth|Section 1455.002. Applicability of Chapter

Sec. 1455.002.  APPLICABILITY OF CHAPTER.  This chapter applies only to a health benefit plan 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 stipulated premium company operating under Chapter 884;  or(v)  a health maintenance organization operating under Chapter 843;  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;  or(2)  is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1455.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1455 - Telemedicine, Teledentistry, and Telehealth|Section 1455.003. Exception

Sec. 1455.003.  EXCEPTION.  This chapter does not apply to:(1)  a plan that provides coverage:(A)  only for a specified disease;(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;  or(D)  as a supplement to a liability insurance policy;(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 1455.002.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|