reglab/housing_qa huggingface dataset:
TX Ins Code § 1201.061 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter B. Policy Terms|Section 1201.061. Coverage for Adopted Child

Sec. 1201.061.  COVERAGE FOR ADOPTED CHILD.  (a)  An individual accident and health insurance policy that provides coverage for an insured's immediate family or children may not, solely because the insured's child is adopted:(1)  exclude the child from coverage;  or(2)  limit coverage for the child.(b)  For the purposes of this section, a child is an insured's child if the insured is a party to a suit in which the insured seeks to adopt the child.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.062 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter B. Policy Terms|Section 1201.062. Coverage for Certain Children in Individual or Group Policy or in Plan or Program

Sec. 1201.062.  COVERAGE FOR CERTAIN CHILDREN IN INDIVIDUAL OR GROUP POLICY OR IN PLAN OR PROGRAM.  (a)  An individual or group accident and health insurance policy that is delivered, issued for delivery, or renewed in this state, including a policy issued by a corporation operating under Chapter 842, or a self-funded or self-insured welfare or benefit plan or program, to the extent that regulation of the plan or program is not preempted by federal law, that provides coverage for a child of an insured or group member, on payment of a premium, must provide coverage for:(1)  each grandchild of the insured or group member if the grandchild is:(A)  unmarried;(B)  younger than 25 years of age; and(C)  a dependent of the insured or group member for federal income tax purposes at the time application for coverage of the grandchild is made; and(2)  each child for whom the insured or group member must provide medical support or dental support, if the policy provides dental coverage, under an order issued under Chapter 154, Family Code, or enforceable by a court in this state.(b)  Coverage for a grandchild of the insured or group member may not be terminated solely because the grandchild is no longer a dependent of the insured or group member for federal income tax purposes.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 57, eff. September 1, 2018.|
TX Ins Code § 1201.063 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter B. Policy Terms|Section 1201.063. Prohibition of Certain Criteria Relating to Child's Coverage in Individual or Group Policy

Sec. 1201.063.  PROHIBITION OF CERTAIN CRITERIA RELATING TO CHILD'S COVERAGE IN INDIVIDUAL OR GROUP POLICY.  Regarding a natural or adopted child of an insured or group member or a child for whom the insured or group member must provide medical support or dental support, if the policy provides dental coverage, under an order issued under Chapter 154, Family Code, or enforceable by a court in this state, an individual or group accident and health insurance policy that provides coverage for a child of an insured or group member may not set a different premium for the child, exclude the child from coverage, or discontinue coverage of the child because:(1)  the child does not reside with the insured or group member; or(2)  the insured or group member does not claim the child as an exemption for federal income tax purposes under Section 151(c), Internal Revenue Code of 1986.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 58, eff. September 1, 2018.|
TX Ins Code § 1201.064 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter B. Policy Terms|Section 1201.064. Coverage for Child of Spouse in Individual or Group Policy

Sec. 1201.064.  COVERAGE FOR CHILD OF SPOUSE IN INDIVIDUAL OR GROUP POLICY.  An individual or group accident and health insurance policy that provides coverage for a child of an insured or group member may not:(1)  set a premium for a child that is different from the premium for other children because the child is the natural or adopted child of the spouse of the insured or group member;(2)  exclude a child described by Subdivision (1) from coverage;  or(3)  discontinue coverage of a child described by Subdivision (1).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.065 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter B. Policy Terms|Section 1201.065. Age and School Enrollment Eligibility Criteria for Dependent Children in Individual or Group Policy; Late Enrollment

Sec. 1201.065.  AGE AND SCHOOL ENROLLMENT ELIGIBILITY CRITERIA FOR DEPENDENT CHILDREN IN INDIVIDUAL OR GROUP POLICY;  LATE ENROLLMENT.  (a)  An individual or group accident and health insurance policy may contain criteria relating to a maximum age or enrollment in school to establish continued eligibility for coverage of a child 25 years of age or older. (b)  In the case of a late enrollment, an insurer may require evidence of insurability that is satisfactory to the insurer before a child is included for coverage under the policy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.023(a), eff. September 1, 2005.|
TX Ins Code § 1201.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.101. Standards for Policy Provisions

Sec. 1201.101.  STANDARDS FOR POLICY PROVISIONS.  (a)  The commissioner shall adopt reasonable rules establishing specific standards for:(1)  the content of an individual accident and health insurance policy;  and(2)  the manner of sale of an individual accident and health insurance policy, including disclosures required to be made in connection with the sale.(b)  Rules adopted under this section must establish standards for:(1)  policy readability;  and(2)  full and fair policy disclosures.(c)  Standards established under this section may include standards that address:(1)  terms of policy renewability;(2)  initial and subsequent conditions of eligibility;(3)  nonduplication of coverage;(4)  coverage of dependents;(5)  preexisting conditions;(6)  termination of insurance;(7)  probationary periods;(8)  limitations;(9)  exceptions;(10)  reductions;(11)  elimination periods;(12)  requirements for replacement;(13)  recurrent conditions;  and(14)  definitions of terms, including definitions of:(A)  "accident";(B)  "accidental means";(C)  "guaranteed renewable and noncancellable";(D)  "hospital";(E)  "injury";(F)  "nervous disorder";(G)  "partial disability";(H)  "physician";(I)  "sickness";  and(J)  "total disability."(d)  A definition of "hospital" adopted under Subsection (c) may not apply to a corporation operating under Chapter 842.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.102. Prohibition of Policy Provisions

Sec. 1201.102.  PROHIBITION OF POLICY PROVISIONS.  The commissioner may adopt rules prohibiting specific individual accident and health insurance policy provisions not specifically authorized by statute that the commissioner determines are unjust, unfair, or unfairly discriminatory to:(1)  the policyholder;(2)  an insured under the policy;  or(3)  a beneficiary.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.103. Compliance With Minimum Standards for Benefits

Sec. 1201.103.  COMPLIANCE WITH MINIMUM STANDARDS FOR BENEFITS.  (a)  An individual accident and health insurance policy must meet the minimum standards for benefits established under Section 1201.104 for each category of coverage provided under the policy.(b)  Subsection (a) does not apply if the commissioner determines that the policy is a supplemental policy or experimental policy or determines that the policy will fulfill a reasonable public need and the policy meets the requirements of Chapter 1701.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.104. Minimum Standards for Benefits

Sec. 1201.104.  MINIMUM STANDARDS FOR BENEFITS.  (a)  For individual accident and health insurance policies, the commissioner shall adopt rules establishing minimum standards for benefits under each of the following categories of coverage:(1)  basic hospital expense;(2)  basic medical-surgical expense;(3)  hospital indemnity or other fixed indemnity;(4)  major medical expense;(5)  disability income protection;(6)  accident only;(7)  specified disease;(8)  specified accident; and(9)  limited benefit.(b)  This section does not prohibit the issuance of an individual accident and health insurance policy that combines categories of coverage listed by this section.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2015, 84th Leg., R.S., Ch. 25 (S.B. 979), Sec. 1, eff. May 15, 2015.|
TX Ins Code § 1201.105 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.105. Minimum Standards for Benefits for Long-Term Care in Individual, Group, or Blanket Policy

Sec. 1201.105.  MINIMUM STANDARDS FOR BENEFITS FOR LONG-TERM CARE IN INDIVIDUAL, GROUP, OR BLANKET POLICY.  (a)  The commissioner shall adopt rules establishing minimum standards for benefits for long-term care coverage under individual, group, and blanket accident and health insurance policies and certificates delivered or issued for delivery in this state.(b)  Rules adopted under this section apply to group coverages delivered or issued for delivery by a corporation operating under Chapter 842.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.106 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.106. Identification of Policies According to Coverage Provided

Sec. 1201.106.  IDENTIFICATION OF POLICIES ACCORDING TO COVERAGE PROVIDED.  The commissioner shall prescribe the method to identify an individual accident and health insurance policy according to the coverages the policy provides.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.107 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.107. Outline of Coverage Required

Sec. 1201.107.  OUTLINE OF COVERAGE REQUIRED.  (a)  An outline of coverage for an individual accident and health insurance policy must be delivered to the applicant at the time application is made, and an acknowledgment of receipt or certificate of delivery of an outline of coverage must be provided to the insurer with the application.(b)  If the policy issued differs from the policy for which the applicant applied, an outline of coverage that properly describes the policy must:(1)  accompany the policy when delivered;  and(2)  clearly state that the policy is not the policy for which the applicant applied.(c)  Subsection (a) does not apply to a direct response insurance product.(d)  An outline of coverage under a direct response insurance product must accompany the policy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.108 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.108. Format and Content of Outline of Coverage

Sec. 1201.108.  FORMAT AND CONTENT OF OUTLINE OF COVERAGE.  (a)  In this section, "format" means style, arrangement, and overall appearance, including:(1)  the size, color, and prominence of type;  and(2)  the arrangement of text and captions.(b)  The commissioner shall prescribe the format and content of an outline of coverage required by Section 1201.107.(c)  An outline of coverage must include:(1)  a statement that identifies the applicable categories of coverage listed by Section 1201.104 and provided by the policy;(2)  a description of the principal benefits and coverage provided by the policy;(3)  a statement of the exceptions, reductions, and limitations in the policy;(4)  a statement of the renewal provision, including any reservation of the insurer's right to change premiums;(5)  a statement that:(A)  the outline is a summary of the policy issued or applied for;  and(B)  the policy should be consulted to determine governing contractual provisions;(6)  as the commissioner determines necessary to carry out the purposes of this chapter, a summary of the provisions required by Subchapter E to be in the policy;  and(7)  any other statement, description, or outline that the commissioner determines is reasonably necessary to carry out the purposes of this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.109 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter C. General Policy Standards and Provisions|Section 1201.109. Notice of Rate Increase for Major Medical Expense Insurance Policy

Sec. 1201.109.  NOTICE OF RATE INCREASE FOR MAJOR MEDICAL EXPENSE INSURANCE POLICY.  (a)  Not less than 60 days before the date on which a premium rate increase takes effect on an individual accident and health insurance policy that provides major medical expense coverage and that is delivered or issued for delivery in this state by an insurer, the insurer shall:(1)  give written notice to the insured of the effective date of the increase; and(2)  provide the insured a table that clearly lists:(A)  the actual dollar amount of the premium on the date of the notice;(B)  the actual dollar amount of the premium after the premium rate increase; and(C)  the percentage change between the amounts described by Paragraphs (A) and (B).(b)  The notice required by this section must be based on coverage in effect on the date of the notice.(c)  This section may not be construed to prevent an insurer, at the request of an insured, from negotiating a change in benefits or rates after delivery of the notice required by this section.(d)  An insurer may not require an insured entitled to notice under this section to respond to the insurer to renew the policy or take other action relating to the renewal or extension of the policy before the 45th day after the date the notice described by Subsection (a) is given.(e)  The notice required by this section must include:(1)  contact information for the department, including information concerning how to file a complaint with the department;(2)  contact information for the Texas Consumer Health Assistance Program, including information concerning how to request from the program consumer protection information or assistance with filing a complaint; and(3)  the addresses of Internet websites that provide consumer information related to rate increase justifications, including the websites of the department and the United States Department of Health and Human Services.(f)  For purposes of this section, "major medical expense coverage" means an individual major medical expense insurance policy to which this chapter applies under Section 1201.003 that constitutes creditable coverage under Section 1205.004.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 3.002, eff. September 1, 2011.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 454 (S.B. 853), Sec. 1, eff. June 14, 2013.Acts 2013, 83rd Leg., R.S., Ch. 454 (S.B. 853), Sec. 2, eff. June 14, 2013.|
TX Ins Code § 1201.151 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter D. Preexisting Conditions|Section 1201.151. Compliance With Subchapter; Prohibition of Defense

Sec. 1201.151.  COMPLIANCE WITH SUBCHAPTER;  PROHIBITION OF DEFENSE.  Except as provided by this subchapter, an individual accident and health insurance policy may not include a provision that permits a defense based on a preexisting condition.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.152 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter D. Preexisting Conditions|Section 1201.152. Coverage Under Simplified Application Form

Sec. 1201.152.  COVERAGE UNDER SIMPLIFIED APPLICATION FORM.  (a)  Notwithstanding Clause (b) of the provision required by Section 1201.208(a), an individual accident and health insurance policy must cover any loss that occurs after 12 months from a preexisting condition if the insurer uses a simplified application form that does not include a question concerning the applicant's health history or medical treatment history.(b)  This section applies regardless of whether the simplified application form includes a question regarding the applicant's health at the time of application.(c)  This section does not require an insurer to cover a loss from a condition that the policy specifically excludes from coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter D. Preexisting Conditions|Section 1201.153. Coverage for Individuals Age 65 or Older

Sec. 1201.153.  COVERAGE FOR INDIVIDUALS AGE 65 OR OLDER.  (a)  Notwithstanding Section 1201.152 or Clause (b) of the provision required by Section 1201.208(a), an individual accident and health insurance policy delivered or issued for delivery to an individual who is 65 years of age or older may not include a provision that excludes from coverage a loss that occurs from a preexisting condition more than six months after the effective date of coverage under the policy.(b)  Notwithstanding Subsection (a), the commissioner may authorize a policy provision that excludes coverage for a preexisting condition for a period of not more than one year if the commissioner determines that the provision would serve the public interest.(c)  This section does not require an insurer to provide coverage for a loss from a preexisting condition specifically excluded from coverage by name or specific description in an exclusion endorsement or rider that is effective on the date of the loss.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1201.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter D. Preexisting Conditions|Section 1201.154. Coverage for Certain Previously Covered Persons

Sec. 1201.154.  COVERAGE FOR CERTAIN PREVIOUSLY COVERED PERSONS.  (a)  In this section, "creditable coverage" has the meaning assigned by Section 1205.004(a).(b)  A preexisting condition provision in an individual accident and health insurance policy may not apply to an individual  who was continuously covered for an aggregate period of 18 months by creditable coverage that was in effect up to a date not more than 63 days before the effective date of the individual coverage, excluding any waiting period.(c)  In determining whether a preexisting condition provision of an individual accident and health insurance policy applies to an individual, an insurer shall credit the time the individual previously was covered under creditable coverage if the previous coverage was in effect at any time during the 18 months preceding the effective date of the individual coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.024, eff. September 1, 2005.Acts 2007, 80th Leg., R.S., Ch. 1070 (H.B. 2548), Sec. 1, eff. June 15, 2007.|
TX Ins Code § 1201.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1201 - Accident and Health Insurance|Subchapter E. Required Policy Provisions|Section 1201.201. Policy Provisions Required

Sec. 1201.201.  POLICY PROVISIONS REQUIRED.  (a)  Except as provided by Subsections (b) and (c), an individual accident and health insurance policy must contain the provisions required by this subchapter in the words provided by this subchapter.(b)  An insurer may substitute for a policy provision required by this subchapter a provision with different wording approved by the commissioner in accordance with reasonable rules adopted by the commissioner.  A substituted provision may not be less favorable to an insured or a beneficiary of the policy than the provision required by this subchapter.(c)  If a policy provision required by this subchapter is wholly or partly inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the commissioner's approval, shall:(1)  omit from the policy each inapplicable provision or part of a provision;  and(2)  modify each inconsistent provision or part of a provision so that the provision as contained in the policy is consistent with the coverage provided by the policy.(d)  A policy provision required by this subchapter must be preceded by the caption for the provision provided by this subchapter or, at the option of the insurer, by an appropriate individual or group caption or subcaption approved by the commissioner.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|