reglab/housing_qa huggingface dataset:
TX Ins Code § 1208.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1208 - Identity of Available Employee of Health Benefit Plan Issuer|Section 1208.001. Applicability of Chapter

Sec. 1208.001.  APPLICABILITY OF CHAPTER.  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)  a reciprocal exchange operating under Chapter 942;(6)  a health maintenance organization operating under Chapter 843;(7)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;  or(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1208.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1208 - Identity of Available Employee of Health Benefit Plan Issuer|Section 1208.002. Disclosure Required

Sec. 1208.002.  DISCLOSURE REQUIRED.  After an oral or written request by an insured or enrollee of a health benefit plan, the plan issuer shall provide to the insured or enrollee the name or employee identifier of the issuer's employee who is available to respond to questions or other communication from the insured or enrollee relating to coverage and benefits provided under the plan to the insured or enrollee.  The issuer shall also provide:(1)  the employee's mailing address;(2)  the municipality and state of the employee's business location;  and(3)  the employee's job title.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1210.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1210 - Notice of Certain Policy Provisions|Section 1210.001. Notice Required

Sec. 1210.001.  NOTICE REQUIRED.  A policy, contract, or certificate of insurance that insures against loss resulting from sickness or accidental bodily injury and that is subject to an increase in the premium at time of renewal or to nonrenewal on the insured attaining a certain age may not be delivered, issued, or used in this state unless the document contains on the first page above the policy provisions a printed notice in 10-point type that states that the policy, contract, or certificate is subject to either or both conditions.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1211.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1211 - Waivers Regarding Certain Federal Health Plans|Section 1211.001. Waiver of Certain Provisions for Certain Federal Plans

|INSURANCE CODETITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGESSUBTITLE A. HEALTH COVERAGE IN GENERALCHAPTER 1211.  WAIVERS REGARDING CERTAIN FEDERAL HEALTH PLANSSec. 1211.001.  WAIVER OF CERTAIN PROVISIONS FOR CERTAIN FEDERAL PLANS.  If the commissioner of insurance, in consultation with the commissioner of health and human services, determines that a provision of Section 843.209 or 843.321, Subchapter J, Chapter 843, Chapter 1213, Subchapter C or C-1, Chapter 1301, or Section 1301.008, 1301.069, or 1301.162 will cause a negative fiscal impact on the state with respect to providing benefits or services under Subchapter XIX, Social Security Act (42 U.S.C. Section 1396 et seq.), as amended, or Subchapter XXI, Social Security Act (42 U.S.C. Section 1397aa et seq.), as amended, the commissioner of insurance by rule shall waive the application of that provision to the providing of those benefits or services.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.027(a), eff. September 1, 2005.|
TX Ins Code § 1213.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1213 - Electronic Health Care Transactions|Section 1213.001. Definition of Health Benefit Plan

Sec. 1213.001.  DEFINITION OF HEALTH BENEFIT PLAN.  (a)  In this chapter, "health benefit plan" means a plan that provides benefits for medical, surgical, or other treatment expenses incurred as a result of a health condition, a mental health condition, an accident, sickness, or substance abuse, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a fraternal benefit society operating under Chapter 885;(4)  a stipulated premium insurance company operating under Chapter 884;(5)  a Lloyd's plan operating under Chapter 941;(6)  an exchange operating under Chapter 942;(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)  The term includes:(1)  a small employer health benefit plan written under Chapter 1501; and(2)  a health benefit plan offered under Chapter 1551, 1575, 1579, or 1601.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.|
TX Ins Code § 1213.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1213 - Electronic Health Care Transactions|Section 1213.002. Electronic Submission of Claims

Sec. 1213.002.  ELECTRONIC SUBMISSION OF CLAIMS.  (a)  The issuer of a health benefit plan by contract may require that a health care professional licensed or registered under the Occupations Code or a health care facility licensed under the Health and Safety Code electronically submit a health care claim or equivalent encounter information, a referral certification, or an authorization or eligibility transaction.  The health benefit plan issuer shall comply with the standards for electronic transactions required by this section and established by the commissioner by rule.(b)  The issuer of a health benefit plan by contract shall establish a default method to submit claims in a nonelectronic format if there is a system failure or failures or a catastrophic event substantially interferes with the normal business operations of the physician, provider, or health benefit plan or its agents.  The health benefit plan issuer shall comply with the standards for nonelectronic transactions established by the commissioner by rule.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.|
TX Ins Code § 1213.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1213 - Electronic Health Care Transactions|Section 1213.003. Electronic Submission of Claims: Waiver

Sec. 1213.003.  ELECTRONIC SUBMISSION OF CLAIMS: WAIVER.  (a)  A contract between the issuer of a health benefit plan and a health care professional or health care facility must provide for a waiver of any requirement for electronic submission established under this chapter.(b)  The commissioner shall establish circumstances under which a waiver is required, including:(1)  circumstances in which no method is available for the submission of claims in electronic form;(2)  the operation of small physician practices;(3)  the operation of other small health care provider practices;(4)  undue hardship, including fiscal or operational hardship; or(5)  any other special circumstance that would justify a waiver.(c)  Any health care professional or health care facility that is denied a waiver by the issuer of a health benefit plan may appeal the denial to the commissioner.  The commissioner shall determine whether a waiver must be granted.(d)  The issuer of a health benefit plan may not refuse to contract or renew a contract with a health care professional or health care facility based in whole or in part on the professional or facility requesting or receiving a waiver or appealing a waiver determination.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.|
TX Ins Code § 1213.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1213 - Electronic Health Care Transactions|Section 1213.004. Mode of Transmission

Sec. 1213.004.  MODE OF TRANSMISSION.  The issuer of a health benefit plan may not by contract limit the mode of electronic transmission that a health care professional or health care facility may use to submit information under this chapter.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.|
TX Ins Code § 1213.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1213 - Electronic Health Care Transactions|Section 1213.005. Certain Charges Prohibited

Sec. 1213.005.  CERTAIN CHARGES PROHIBITED.  A health benefit plan may not directly or indirectly charge or hold a health care professional, health care facility, or person enrolled in a health benefit plan responsible for a fee for the adjudication of a claim.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.|
TX Ins Code § 1213.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1213 - Electronic Health Care Transactions|Section 1213.006. Rules

Sec. 1213.006.  RULES.  The commissioner may adopt rules as necessary to implement this chapter.  The commissioner may not require any data element for electronically filed claims that is not required to comply with federal law.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.|
TX Ins Code § 1214.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1214 - Advertising for Certain Health Benefits|Section 1214.001. Applicability of Chapter

Sec. 1214.001.  APPLICABILITY OF CHAPTER.  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 agreement, a group hospital service contract, or an individual or group evidence of coverage issued by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a health maintenance organization operating under Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapter 222, 251, or 258, as applicable to a health maintenance organization, Chapter 843, Chapter 1271, and Chapter 1272; or(4)  an approved nonprofit health corporation holding a certificate of authority under Chapter 844.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.001, eff. April 1, 2009.|
TX Ins Code § 1214.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1214 - Advertising for Certain Health Benefits|Section 1214.002. Exception

Sec. 1214.002.  EXCEPTION.  This chapter does not apply to:(1)  a health benefit plan that provides coverage:(A)  only for a specified disease;(B)  only for accidental death or dismemberment; or(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(2)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefits so comprehensive that the policy is a health benefit plan as described by Section 1214.001.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.001, eff. April 1, 2009.|
TX Ins Code § 1214.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1214 - Advertising for Certain Health Benefits|Section 1214.003. Rate Information Disclaimers

Sec. 1214.003.  RATE INFORMATION DISCLAIMERS.  (a)  Subject to Chapter 541 and Section 543.001, an advertisement for a health benefit plan may include rate information without including information about each benefit exclusion or limitation if the advertisement includes prominent disclaimers clearly indicating that:(1)  the rates are illustrative;(2)  a person should not send money to the health benefit plan issuer in response to the advertisement;(3)  a person cannot obtain coverage under the plan until the person completes an application for coverage; and(4)  benefit exclusions or limitations may apply to the plan.(b)  An advertisement that states a rate must also indicate the age, gender, and geographic location on which the rate is based.|Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.001, eff. April 1, 2009.|
TX Ins Code § 1215.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1215 - Reporting of Claims Information|Section 1215.001. Definitions

Sec. 1215.001.  DEFINITIONS.  (a)  Except as provided by Subsection (b), in this chapter:(1)  "Employer" has the meaning assigned by 29 U.S.C. Section 1002(5).(2)  "Governmental entity" means a state agency or political subdivision of this state.(3)  "Group health plan" has the meaning assigned by 45 C.F.R. Section 160.103, except that the term does not include disability income or long-term care insurance.(4)  "Health insurance issuer" has the meaning assigned by 45 C.F.R. Section 160.103.(5)  "Plan" means an employee welfare benefit plan as defined by 29 U.S.C. Section 1002(1).(6)  "Plan administrator" means an administrator as defined by 29 U.S.C. Section 1002(16)(A).(7)  "Plan sponsor" has the meaning assigned by 29 U.S.C. Section 1002(16)(B).(8)  "Political subdivision" means a county, municipality, school district, special-purpose district, or other subdivision of state government that has jurisdiction limited to a geographic portion of the state.(9)  "Protected health information" has the meaning assigned by 45 C.F.R. Section 160.103.(b)  A reference to a federal statute or regulation under Subsection (a) means that statute or regulation as it existed on September 1, 2007, except that the commissioner, by rule, may adopt a definition based on a later amended, enacted, or adopted federal statute or regulation if the commissioner determines that use of the later amended, enacted, or adopted statute or regulation is consistent with the purposes of this chapter and promotes regulatory consistency.|Added by Acts 2007, 80th Leg., R.S., Ch. 700 (H.B. 2015), Sec. 1, eff. September 1, 2007.|
TX Ins Code § 1215.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1215 - Reporting of Claims Information|Section 1215.002. Applicability of Chapter to Governmental Entity; Applicability of Other Law With Reference to Governmental Entity

Sec. 1215.002.  APPLICABILITY OF CHAPTER TO GOVERNMENTAL ENTITY; APPLICABILITY OF OTHER LAW WITH REFERENCE TO GOVERNMENTAL ENTITY.  (a)  This chapter applies to a governmental entity that enters into a contract with a health insurance issuer that results in the health insurance issuer delivering, issuing for delivery, or renewing a group health plan.(b)  For purposes of this chapter, a health insurance issuer shall treat a governmental entity described by Subsection (a) as a plan sponsor or plan administrator.(c)  A report of claim information provided under this section to a governmental entity is confidential and exempt from public disclosure under Chapter 552, Government Code.|Added by Acts 2007, 80th Leg., R.S., Ch. 700 (H.B. 2015), Sec. 1, eff. September 1, 2007.|
TX Ins Code § 1215.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1215 - Reporting of Claims Information|Section 1215.004. Request for Additional Information

Sec. 1215.004.  REQUEST FOR ADDITIONAL INFORMATION.  (a)  On receipt of the report required by Section 1215.003(a), the plan, plan sponsor, or plan administrator may review the report and, not later than the 10th day after the date the report is received, may make a written request to the health insurance issuer for additional information in accordance with this section for specified individuals.(b)  With respect to a request for additional information concerning specified individuals for whom claims information has been provided under Section 1215.003(c)(5), the health insurance issuer shall provide additional information on the prognosis or recovery if available and, for individuals in active case management, the most recent case management information, including any future expected costs and treatment plan, that relate to the claims for that individual.(c)  The health insurance issuer must respond to the request for additional information under this section not later than the 15th day after the date of the request under this section unless the requesting plan, plan sponsor, or plan administrator agrees to a request for additional time.(d)  The health insurance issuer is not required to produce the report described by this section unless a certification has been provided in accordance with Section 1215.003(e).|Added by Acts 2007, 80th Leg., R.S., Ch. 700 (H.B. 2015), Sec. 1, eff. September 1, 2007.|
TX Ins Code § 1215.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1215 - Reporting of Claims Information|Section 1215.005. Compliance With Chapter Does Not Create Liability

Sec. 1215.005.  COMPLIANCE WITH CHAPTER DOES NOT CREATE LIABILITY.  A health insurance issuer that releases information, including protected health information, in accordance with this chapter has not violated a standard of care and is not liable for civil damages resulting from, and is not subject to criminal prosecution for, releasing that information.|Added by Acts 2007, 80th Leg., R.S., Ch. 700 (H.B. 2015), Sec. 1, eff. September 1, 2007.|
TX Ins Code § 1215.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1215 - Reporting of Claims Information|Section 1215.006. Administrative Penalties

Sec. 1215.006.  ADMINISTRATIVE PENALTIES.  A health insurance issuer that does not comply with this chapter is subject to administrative penalties under Chapter 84.|Added by Acts 2007, 80th Leg., R.S., Ch. 700 (H.B. 2015), Sec. 1, eff. September 1, 2007.|
TX Ins Code § 1216.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1216 - Out-of-Country Coverage Prohibited|Section 1216.001. Definitions

Sec. 1216.001.  DEFINITIONS.  In this chapter:(1)  "Enrollee" means an individual entitled to coverage under a health benefit plan.(2)  "Foreign country" means a governmental unit other than:(A)  the United States;(B)  a state, district, commonwealth, territory, or insular possession of the United States;(C)  the Panama Canal Zone; or(D)  the Trust Territory of the Pacific Islands.(3)  "Health care service" means a service to diagnose, prevent, alleviate, cure, or heal a health condition, sickness, or injury that is provided to an enrollee by a physician or other health care provider.|Added by Acts 2007, 80th Leg., R.S., Ch. 1322 (S.B. 1391), Sec. 1, eff. September 1, 2007.Renumbered from Insurance Code, Section 1215.001 by Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 27.001(62), eff. September 1, 2009.|
TX Ins Code § 1216.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1216 - Out-of-Country Coverage Prohibited|Section 1216.002. Applicability of Chapter

Sec. 1216.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan that provides benefits for health care services, including medical or surgical expenses, incurred as a result of a health condition, accident, or sickness, including:(1)  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:(A)  an insurance company;(B)  a group hospital service corporation operating under Chapter 842;(C)  a fraternal benefit society operating under Chapter 885;(D)  a stipulated premium company operating under Chapter 884; or(E)  a health maintenance organization operating under Chapter 843; and(2)  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:(A)  a multiple employer welfare arrangement as defined by Section 3 of that Act; or(B)  another analogous benefit arrangement.(b)  For purposes of Subsection (a), a health benefit plan includes a consumer choice of benefits plan issued under Chapter 1507.|Added by Acts 2007, 80th Leg., R.S., Ch. 1322 (S.B. 1391), Sec. 1, eff. September 1, 2007.Renumbered from Insurance Code, Section 1215.002 by Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 27.001(62), eff. September 1, 2009.|
TX Ins Code § 1216.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1216 - Out-of-Country Coverage Prohibited|Section 1216.003. Exception

Sec. 1216.003.  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;(D)  as a supplement to a liability insurance policy;(E)  only for dental or vision care;(F)  only for indemnity for hospital confinement; or(G)  only for health care services provided to an enrollee while the enrollee is traveling to, visiting, or residing in a foreign country;(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 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 1216.002.|Added by Acts 2007, 80th Leg., R.S., Ch. 1322 (S.B. 1391), Sec. 1, eff. September 1, 2007.Renumbered from Insurance Code, Section 1215.003 by Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 27.001(62), eff. September 1, 2009.Renumbered from Insurance Code, Section 1215.003 and amended by Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 27.002(12), eff. September 1, 2009.|