reglab/housing_qa huggingface dataset:
TX Ins Code § 1451.255 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter F. Access to Obstetrical or Gynecological Care|Section 1451.255. Right of Female Enrollee to Select Obstetrician or Gynecologist

Sec. 1451.255.  RIGHT OF FEMALE ENROLLEE TO SELECT OBSTETRICIAN OR GYNECOLOGIST.  (a)  Except as provided by Subsection (b), a health benefit plan shall permit a female enrollee to select, in addition to a primary care physician, an obstetrician or gynecologist to provide the enrollee with health care services that are within the scope of the professional specialty practice of a properly credentialed obstetrician or gynecologist.(b)  A health benefit plan may limit an enrollee's self-referral under Subsection (a) to only one participating obstetrician or gynecologist to provide both gynecological and obstetrical care to the enrollee.  This subsection does not affect the right of an enrollee to select the physician who provides that care.(c)  This section does not preclude an enrollee from selecting a qualified physician, including a family physician or internal medicine physician, to provide the enrollee with health care services described by Subsection (a).(d)  This section does not affect the authority of a health benefit plan issuer to establish selection criteria regarding other physicians who provide services under the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.256 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter F. Access to Obstetrical or Gynecological Care|Section 1451.256. Direct Access to Services of Obstetrician or Gynecologist

Sec. 1451.256.  DIRECT ACCESS TO SERVICES OF OBSTETRICIAN OR GYNECOLOGIST.  (a)  In this section, "health care services" includes:(1)  one well-woman examination each year;(2)  care related to pregnancy;(3)  care for any active gynecological condition;  and(4)  diagnosis, treatment, and referral for any disease or condition that is within the scope of the professional specialty practice of a properly credentialed obstetrician or gynecologist.(b)  In addition to other benefits authorized under the health benefit plan, a health benefit plan shall permit an enrollee who selects an obstetrician or gynecologist under Section 1451.255 to have direct access to the health care services of that selected physician without:(1)  a referral from the enrollee's primary care physician;  or(2)  prior authorization or precertification from the plan issuer.(c)  A health benefit plan may not impose a copayment or deductible for direct access to health care services as required by this section unless the same copayment or deductible is imposed for access to other health care services provided under the plan.(d)  This section does not affect the authority of a health benefit plan issuer to require an obstetrician or gynecologist selected by an enrollee under Section 1451.255 to forward information concerning the medical care of the enrollee to the enrollee's primary care physician.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.257 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter F. Access to Obstetrical or Gynecological Care|Section 1451.257. Availability of Providers

Sec. 1451.257.  AVAILABILITY OF PROVIDERS.  To ensure access to services that are within the scope of the professional specialty practice of a properly credentialed obstetrician or gynecologist, a health benefit plan shall include in the classification of persons authorized to provide medical services under the plan a sufficient number of properly credentialed obstetricians and gynecologists.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.258 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter F. Access to Obstetrical or Gynecological Care|Section 1451.258. Notice of Available Providers

Sec. 1451.258.  NOTICE OF AVAILABLE PROVIDERS.  (a)  A health benefit plan issuer shall provide to each person covered under the plan a timely written notice of the choices of the types of physician providers available for the direct access required under this subchapter.(b)  The notice must be stated in clear and accurate language.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.259 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter F. Access to Obstetrical or Gynecological Care|Section 1451.259. Limits on Physician Sanctions

Sec. 1451.259.  LIMITS ON PHYSICIAN SANCTIONS.  (a)  A health benefit plan may not sanction or terminate a primary care physician because of female enrollees' access to participating obstetricians and gynecologists under this subchapter.(b)  A health benefit plan may not impose a financial or other penalty on an obstetrician or gynecologist selected under Section 1451.255, or on the enrollee who selected the physician, because the selected physician failed to provide to the enrollee's primary care physician information concerning the medical care of the enrollee if the selected physician made a reasonable good faith effort to forward the information.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.260 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter F. Access to Obstetrical or Gynecological Care|Section 1451.260. Administrative Penalty

Sec. 1451.260.  ADMINISTRATIVE PENALTY.  An entity that operates a health benefit plan in violation of this subchapter is subject to an administrative penalty as provided by Chapter 84.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.301 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter G. Access to Dietitian Services|Section 1451.301. Applicability of General Provisions of Other Law

Sec. 1451.301.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW.  The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, the construction of policies under that chapter, rulemaking under that chapter, and definitions of terms applicable in that chapter, apply to this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.302 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter G. Access to Dietitian Services|Section 1451.302. Dietitian Services

Sec. 1451.302.  DIETITIAN SERVICES.  An individual or group accident and health insurance policy delivered or issued for delivery in this state may not:(1)  exclude or deny coverage for services performed by:(A)  a dietitian;  or(B)  a provisionally licensed dietitian acting under the supervision of a dietitian;  or(2)  refuse payment or reimbursement for charges for services described by Subdivision (1) if the services:(A)  are in the scope of the dietitian's license;(B)  are related to an injury or illness the policy covers if the services are scheduled in the policy;  and(C)  are provided under a professional recommendation of a physician whose treatment or examination for the injury or illness would be covered by the policy and would be payable or reimbursable under the policy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.351 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter H. Disability Certified by Podiatrist|Section 1451.351. Loss of Income Benefits for Disability Treatable by Podiatrist

Sec. 1451.351.  LOSS OF INCOME BENEFITS FOR DISABILITY TREATABLE BY PODIATRIST.  (a)  This section applies only to an insurance policy delivered, issued for delivery, or renewed in this state that provides benefits covering loss of income as a result of an acute temporary disability caused by sickness or injury.(b)  An insurance policy may not deny payment of benefits described by Subsection (a) solely because the disability is certified or attested to by a podiatrist if the disability is caused by a sickness or injury that may be treated within the scope of the podiatrist's license.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.401 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter I. Use of Osteopathic Hospital|Section 1451.401. Contract With Osteopathic Hospital

Sec. 1451.401.  CONTRACT WITH OSTEOPATHIC HOSPITAL.  A health maintenance organization or preferred provider benefit plan issuer that contracts with a hospital to provide services to covered individuals may not refuse to contract with an osteopathic hospital solely because the hospital is an osteopathic hospital.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.402 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter I. Use of Osteopathic Hospital|Section 1451.402. Services at Osteopathic Hospital

Sec. 1451.402.  SERVICES AT OSTEOPATHIC HOSPITAL.  A health maintenance organization or preferred provider benefit plan issuer that provides benefits for inpatient or outpatient services provided by an allopathic hospital shall seek to provide benefits for similar services provided by an osteopathic hospital if there is an osteopathic hospital within the service area of the health maintenance organization or preferred provider benefit plan issuer that will provide the services at a substantially similar cost.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.403 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter I. Use of Osteopathic Hospital|Section 1451.403. Request for Action of Commissioner

Sec. 1451.403.  REQUEST FOR ACTION OF COMMISSIONER.  An aggrieved party may request that the commissioner conduct an investigation, review, hearing, or other proceeding to determine compliance with this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.404 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter I. Use of Osteopathic Hospital|Section 1451.404. Enforcement

Sec. 1451.404.  ENFORCEMENT.  The commissioner shall take all reasonable actions to ensure compliance with this subchapter, including issuing orders and assessing penalties.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1451.451 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter J. Reimbursement of Health Care Providers|Section 1451.451. Reimbursement Under Medicaid-Based Fee Schedule

Sec. 1451.451.  REIMBURSEMENT UNDER MEDICAID-BASED FEE SCHEDULE.  (a)  An insurance company, health maintenance organization, or preferred provider organization that contracts with a health care provider to provide services in connection with Chapter 533, Government Code, or Chapter 62, Health and Safety Code, may not require the health care provider to provide access to or transfer the provider's name and contracted discounted fee for use with health benefit plans issued to individuals and groups under Chapter 1271 or 1301.(b)  An insurance company, health maintenance organization, or preferred provider organization may provide access to or transfer a provider's name and discounted fee described by Subsection (a) only if:(1)  the insurance company, health maintenance organization, or preferred provider organization provides written notice to the provider that is printed in conspicuous boldface type near a separate signature line and includes a statement substantially similar to the following:  "By signing on this line, you may be agreeing to apply this company's Medicaid or CHIP fee schedule to services you provide to commercial insurance or HMO enrollees."; and(2)  the provider authorizes the access or transfer and agrees to accept the contracted discounted fee by signing the notice described in Subdivision (1).|Added by Acts 2013, 83rd Leg., R.S., Ch. 778 (S.B. 1221), Sec. 1, eff. June 14, 2013.|
TX Ins Code § 1451.501 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter K. Health Care Provider Directories|Section 1451.501. Definitions

Sec. 1451.501.  DEFINITIONS.  In this subchapter:(1)  "Facility" has the meaning assigned by Section 324.001, Health and Safety Code.(1-a)  "Facility-based physician" means a radiologist, anesthesiologist, pathologist, emergency department physician, neonatologist, or assistant surgeon:(A)  to whom a facility has granted clinical privileges; and(B)  who provides services to patients of the facility under those clinical privileges.(1-b)  "Health care provider" means a practitioner, institutional provider, or other person or organization that furnishes health care services and that is licensed or otherwise authorized to practice in this state.  The term includes a pharmacist, pharmacy, hospital, nursing home, or other medical or health-related service facility that provides care for the sick or injured or other care.  The term does not include a physician.(2)  "Physician" means an individual licensed to practice medicine in this state.|Added by Acts 2015, 84th Leg., R.S., Ch. 1038 (H.B. 1624), Sec. 2, eff. September 1, 2015.Amended by: Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742), Sec. 1.01, eff. September 1, 2019.|
TX Ins Code § 1451.502 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter K. Health Care Provider Directories|Section 1451.502. Applicability of Subchapter

Sec. 1451.502.  APPLICABILITY OF SUBCHAPTER.  This subchapter 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 a small or large employer group contract 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 2015, 84th Leg., R.S., Ch. 1038 (H.B. 1624), Sec. 2, eff. September 1, 2015.|
TX Ins Code § 1451.503 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter K. Health Care Provider Directories|Section 1451.503. Exception

Sec. 1451.503.  EXCEPTION.  This subchapter does not apply to:(1)  a health benefit plan that provides coverage:(A)  only for a specified disease or for another single 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;(E)  for credit insurance;(F)  only for dental or vision care;(G)  only for hospital expenses; or(H)  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), as amended;(3)  a workers' compensation insurance policy;(4)  medical payment insurance coverage provided under a motor vehicle insurance policy;(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 1451.502;(6)  the child health plan program under Chapter 62, Health and Safety Code, or the health benefits plan for children under Chapter 63, Health and Safety Code; or(7)  a Medicaid managed care program operated under Chapter 533, Government Code, or a Medicaid program operated under Chapter 32, Human Resources Code.|Added by Acts 2015, 84th Leg., R.S., Ch. 1038 (H.B. 1624), Sec. 2, eff. September 1, 2015.|
TX Ins Code § 1451.504 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter K. Health Care Provider Directories|Section 1451.504. Physician and Health Care Provider Directories

Sec. 1451.504.  PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORIES.  (a)  A health benefit plan issuer that offers coverage for health care services through preferred providers, exclusive providers, or a network of physicians or health care providers shall develop and maintain a physician and health care provider directory in accordance with this subchapter.(b)  The directory must include the name, street address, specialty, if any, and telephone number of each physician and health care provider described by Subsection (a) and indicate whether the physician or provider is accepting new patients.(c)  For each health care provider that is a facility included in the directory under this section, the directory must:(1)  list under the facility name separate headings for radiologists, anesthesiologists, pathologists, emergency department physicians, neonatologists, and assistant surgeons;(2)  list under each heading described by Subdivision (1) each facility-based physician described by Subsection (a) practicing in the specialty corresponding with that heading that is a preferred provider, exclusive provider, or network physician;(3)  for the facility and each facility-based physician described by Subdivision (2), clearly indicate each health benefit plan issued by the issuer that may provide coverage for the services provided by that facility or physician; and(4)  include the facility in a listing of all facilities included in the directory indicating:(A)  the name of the facility;(B)  the municipality in which the facility is located or county in which the facility is located if the facility is in the unincorporated area of the county;(C)  for each specialty of facility-based physician practicing at the facility, the name, street address, and telephone number of any facility-based physician that is a preferred provider, exclusive provider, or network physician or of the physician group in which the facility-based physician practices;(D)  each health benefit plan issued by the issuer that may provide coverage for the services provided by the facility; and(E)  each health benefit plan issued by the issuer that may provide coverage for the services provided by each facility-based physician group.(d)  The directory must list a facility-based physician individually and, if the physician belongs to a physician group, as part of the physician group.|Added by Acts 2015, 84th Leg., R.S., Ch. 1038 (H.B. 1624), Sec. 2, eff. September 1, 2015.Amended by: Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742), Sec. 1.02, eff. September 1, 2019.|
TX Ins Code § 1451.505 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle F - Physicians and Health Care Providers|Chapter 1451 - Access to Certain Practitioners and Facilities|Subchapter K. Health Care Provider Directories|Section 1451.505. Physician and Health Care Provider Directory on Internet Website

Sec. 1451.505.  PHYSICIAN AND HEALTH CARE PROVIDER DIRECTORY ON INTERNET WEBSITE.  (a) A health benefit plan issuer shall display on a public Internet website maintained by the issuer the directory required by Section 1451.504.  A direct electronic link to the directory must be displayed in a conspicuous manner in the electronic summary of benefits and coverage of each health benefit plan issued by the health benefit plan issuer on the Internet website.(b)  The health benefit plan issuer shall clearly indicate in the directory each health benefit plan issued by the issuer that may provide coverage for services provided by each physician or health care provider included in the directory.(c)  The directory must be:(1)  electronically searchable by physician or health care provider name, specialty, if any, facility, and location; and(2)  publicly accessible without necessity of providing a password, a user name, or personally identifiable information.(d)  The health benefit plan issuer shall conduct an ongoing review of the directory and correct or update the information as necessary. Except as provided by Subsection (e), corrections and updates, if any, must be made not less than once each month.(e)  The health benefit plan issuer shall conspicuously display in the directory required by Section 1451.504 an e-mail address and a toll-free telephone number to which any individual may report any inaccuracy in the directory. If the issuer receives a report from any person that specifically identified directory information may be inaccurate, the issuer shall investigate the report and correct the information, as necessary, not later than the seventh day after the date the report is received.|Added by Acts 2015, 84th Leg., R.S., Ch. 1038 (H.B. 1624), Sec. 2, eff. September 1, 2015.Amended by: Acts 2019, 86th Leg., R.S., Ch. 1218 (S.B. 1742), Sec. 1.03, eff. September 1, 2019.|