reglab/housing_qa huggingface dataset:
TX Ins Code § 1254.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1254 - Notice of Rate Increase for Group Health and Accident Coverage|Section 1254.001. Notice of Rate Increase

Sec. 1254.001.  NOTICE OF RATE INCREASE.  (a)  In this section, "insurer" means:(1)  a life insurance company;(2)  a health insurance company;(3)  an accident insurance company;(4)  a general casualty company;(5)  a mutual life insurance company or other mutual insurance company;(6)  a mutual or natural premium life insurance company;(7)  a Lloyd's plan;(8)  a reciprocal or interinsurance exchange;(9)  a fraternal benefit society;(10)  a local mutual aid association;  or(11)  a group hospital service corporation.(b)  Not less than 60 days before the date on which a premium rate increase takes effect on a group policy of health insurance, accident and health insurance, or life, health, and accident insurance delivered or issued for delivery in this state by an insurer, the insurer shall give written notice to the policyholder of:(1)  the amount of the increase; and(2)  the date on which the increase is to take effect.(c)  A health maintenance organization shall give notice of an increase in subscriber charges and service fees under a group contract or coverage in the same manner as is required of an insurer under Subsection (b).(d)  An insurer that issues a group policy described by Subsection (b) to a multiple employer trust shall give the notice required by that subsection to the trustee or group policyholder.(e)  The notice required by this section must be based on coverage in effect on the date of the notice.(f)  This section may not be construed to prevent an insurer or health maintenance organization, at the request of a policyholder or contract holder, from negotiating a change in benefits or rates after delivery of the notice required by this section.(g)  An insurer may not require a policyholder or trustee 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 (b) is given.|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. 11.031(a), eff. September 1, 2005.|
TX Ins Code § 1274.0015 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1274 - Electronic Transmission of Eligibility and Payment Status|Section 1274.0015. Exemption

Sec. 1274.0015.  EXEMPTION.  This chapter does not apply to a single-service health maintenance organization that provides coverage only for dental or vision benefits.|Added by Acts 2005, 79th Leg., Ch. 880 (S.B. 1149), Sec. 1, eff. September 1, 2005.|
TX Ins Code § 1274.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1274 - Electronic Transmission of Eligibility and Payment Status|Section 1274.002. Transmission of Enrollee Eligibility and Payment Status

Sec. 1274.002.  TRANSMISSION OF ENROLLEE ELIGIBILITY AND PAYMENT STATUS.  (a)  Each health benefit plan issuer shall, upon the participating provider's submission of the patient's name, relationship to the primary enrollee, and birth date, make available telephonically, electronically, or by an Internet website portal to each participating provider information maintained in the ordinary course of business and sufficient for the provider to determine at the time of the enrollee's visit information concerning:(1)  the enrollee, including:(A)  the enrollee's identification number assigned by the health benefit plan issuer;(B)  the name of the enrollee and all covered dependents, if appropriate;(C)  the birth date of the enrollee and the birth dates of all covered dependents, if appropriate;(D)  the gender of the enrollee and the gender of each covered dependent, if appropriate; and(E)  the current enrollment and eligibility status of the enrollee under the health benefit plan;(2)  the enrollee's benefits, including:(A)  whether a specific type or category of service is a covered benefit; and(B)  excluded benefits or limitations, both group and individual; and(3)  the enrollee's financial information, including:(A)  copayment requirements, if any; and(B)  the unmet amount of the enrollee's deductible or enrollee financial responsibility.(b)  Information required to be made available under this section may be made available only to a participating provider who is authorized under state and federal law to receive personally identifiable information on an enrollee or dependent.|Added by Acts 2005, 79th Leg., Ch. 880 (S.B. 1149), Sec. 1, eff. September 1, 2005.|
TX Ins Code § 1274.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1274 - Electronic Transmission of Eligibility and Payment Status|Section 1274.003. Certain Charges Prohibited

Sec. 1274.003.  CERTAIN CHARGES PROHIBITED.  A health benefit plan issuer may not directly or indirectly charge or hold a physician, health care provider, or enrollee responsible for a fee for making available or accessing information under this chapter.|Added by Acts 2005, 79th Leg., Ch. 880 (S.B. 1149), Sec. 1, eff. September 1, 2005.|
TX Ins Code § 1274.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1274 - Electronic Transmission of Eligibility and Payment Status|Section 1274.004. Rules

Sec. 1274.004.  RULES.  (a)  The commissioner shall adopt rules as necessary to implement this chapter.(b)  Before adopting rules under this section, the commissioner shall consult and receive advice from the technical advisory committee on claims processing established under Chapter 1212.|Added by Acts 2005, 79th Leg., Ch. 880 (S.B. 1149), Sec. 1, eff. September 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.006, eff. April 1, 2009.|
TX Ins Code § 1274.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle C - Managed Care|Chapter 1274 - Electronic Transmission of Eligibility and Payment Status|Section 1274.005. Waiver of Certain Provisions for Certain Federal Plans

Sec. 1274.005.  WAIVER OF CERTAIN PROVISIONS FOR CERTAIN FEDERAL PLANS.  If the commissioner, in consultation with the commissioner of health and human services, determines that a provision of Section 1274.002 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.), or Subchapter XXI, Social Security Act (42 U.S.C. Section 1397aa et seq.), 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. 880 (S.B. 1149), Sec. 1, eff. September 1, 2005.|
TX Ins Code § 1351.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.001. Definitions

Sec. 1351.001.  DEFINITIONS.  In this chapter:(1)  "Health services" includes:(A)  skilled nursing by a registered nurse or a licensed vocational nurse under the supervision of at least one registered nurse and at least one physician;(B)  physical, occupational, speech, or respiratory therapy;(C)  the services of a home health aide under the supervision of a registered nurse;  and(D)  the furnishing of medical equipment and supplies other than drugs or medicines.(2)  "Home health agency" means a business that:(A)  provides home health services;  and(B)  is licensed by the Texas Department of Human Services under Chapter 142, Health and Safety Code.(3)  "Home health services" means the provision of health services for payment or other consideration in a patient's residence under a plan of care that is:(A)  established, approved in writing, and reviewed at least every two months by the attending physician;  and(B)  certified by the attending physician as necessary for medical purposes.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.002. Applicability of Chapter

Sec. 1351.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies to a group health benefit plan that is delivered or issued for delivery in this state and that is a group policy of accident and health insurance, including a policy issued by a group hospital service corporation operating under Chapter 842.(b)  This chapter applies to an accident and health insurance policy issued by a stipulated premium company subject to Chapter 884.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.003. Applicability of General Provisions of Other Law

Sec. 1351.003.  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 chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.004. Exception

Sec. 1351.004.  EXCEPTION.  This chapter does not apply to:(1)  a group policy of accident and health insurance that provides coverage only for:(A)  a specified disease or diseases;(B)  vision care;(C)  dental care;(D)  hospital indemnity;(E)  prescription drugs;  or(F)  other limited benefits;(2)  a blanket insurance policy, as described by Chapter 1251;(3)  a short-term travel insurance policy;(4)  an accident-only insurance policy;(5)  a hospital indemnity insurance policy;(6)  a limited or specified disease insurance policy;(7)  an insurance policy or contract issued under a right of conversion;  or(8)  an insurance policy or contract designed for issuance to a person eligible for Medicare coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.005. Coverage Required

Sec. 1351.005.  COVERAGE REQUIRED.  Except as provided by Section 1351.008, a group health benefit plan must provide coverage for home health services provided by a home health agency.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.006. Reimbursement for Home Health Services: Physician Certification Required

Sec. 1351.006.  REIMBURSEMENT FOR HOME HEALTH SERVICES:  PHYSICIAN CERTIFICATION REQUIRED.  A group health benefit plan issuer may not provide reimbursement for home health services provided under the plan unless the attending physician certifies that hospitalization or confinement in a skilled facility would be required if a treatment plan for home health care were not provided.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.007 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.007. Limitations and Exclusions on Coverage Permitted

Sec. 1351.007.  LIMITATIONS AND EXCLUSIONS ON COVERAGE PERMITTED.  (a)  A group health benefit plan may include:(1)  a limitation on the number of visits for home health services for which benefits are payable, subject to Subsection (b);(2)  an exclusion for home health services coverage for:(A)  custodial care;(B)  services provided by an individual who:(i)  resides in the covered individual's home;  or(ii)  is a member of the covered individual's family;  or(C)  services provided to a covered individual who is eligible for Medicare coverage;(3)  annual deductible and coinsurance provisions for home health services coverage that are not less favorable than the deductible or coinsurance provisions applicable to hospital services coverage under the plan;  and(4)  other coverage limitations or exclusions consistent with the remaining provisions of the plan.(b)  A limitation under Subsection (a)(1) may not limit each individual covered under the plan to fewer than 60 visits in any calendar year or continuous 12-month period.(c)  For purposes of this section, each of the following is considered to be one visit for home health services:(1)  a visit by a representative of a home health agency;(2)  four hours of home health aide service;  and(3)  if home health aide service extends beyond four hours, each additional four hours or portion of that four-hour period.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.008 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.008. Rejection of Coverage by Plan Holder; Negotiation of Alternative Coverage

Sec. 1351.008.  REJECTION OF COVERAGE BY PLAN HOLDER;  NEGOTIATION OF ALTERNATIVE COVERAGE.  (a)  If the holder of a group health benefit plan rejects in writing the coverage required under this chapter, the plan issuer:(1)  may not include the coverage in the plan;  and(2)  is not required to:(A)  offer the coverage to the plan holder;  or(B)  provide the coverage under the plan.(b)  If a plan holder rejects in writing the coverage required under this chapter, the plan holder and the plan issuer may negotiate coverage for home health services other than the coverage required under this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1351.009 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1351 - Home Health Services|Section 1351.009. Additional Coverage Not Precluded

Sec. 1351.009.  ADDITIONAL COVERAGE NOT PRECLUDED.  This chapter does not preclude a group health benefit plan issuer from providing coverage for home health services that exceeds the coverage required under this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1352.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1352 - Brain Injury|Section 1352.001. Applicability of Chapter

Sec. 1352.001.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan, including, subject to this chapter, a small employer health benefit plan written under Chapter 1501, 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.(c)  This chapter applies to group health coverage made available by a school district in accordance with Section 22.004, Education Code.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 1, eff. September 1, 2007.Acts 2013, 83rd Leg., R.S., Ch. 370 (H.B. 2929), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1352.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1352 - Brain Injury|Section 1352.002. Exception; Application to Qualified Health Plan

Sec. 1352.002.  EXCEPTION; APPLICATION TO QUALIFIED HEALTH PLAN.  (a) This chapter does not apply to:(1)  a plan that provides coverage:(A)  only for a specified disease or for another limited benefit other than an accident policy;(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; 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 1352.001.(b)  This chapter does not apply to a standard health benefit plan issued under Chapter 1507.(c)  To the extent that a change in law made to this chapter after January 1, 2013, 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 under this section that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 370 (H.B. 2929), Sec. 2, eff. September 1, 2013.|
TX Ins Code § 1352.0035 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1352 - Brain Injury|Section 1352.0035. Required Coverages--Small Employer Health Benefit Plans

Sec. 1352.0035.  REQUIRED COVERAGES--SMALL EMPLOYER HEALTH BENEFIT PLANS.  (a)  A small employer health benefit plan may not exclude coverage for cognitive rehabilitation therapy, cognitive communication therapy, neurocognitive therapy and rehabilitation, neurobehavioral, neurophysiological, neuropsychological, or psychophysiological testing or treatment, neurofeedback therapy, remediation, post-acute transition services, or community reintegration services necessary as a result of and related to an acquired brain injury.(b)  Coverage required under this section may be subject to deductibles, copayments, coinsurance, or annual or maximum amount limits that are consistent with the deductibles, copayments, coinsurance, or annual or maximum amount  limits applicable to other medical conditions for which coverage is provided under the small employer health benefit plan.(c)  The commissioner shall adopt rules as necessary to implement this section.|Added by Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 3, eff. September 1, 2007.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 370 (H.B. 2929), Sec. 4, eff. September 1, 2013.|
TX Ins Code § 1352.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1352 - Brain Injury|Section 1352.004. Training for Certain Personnel Required

Sec. 1352.004.  TRAINING FOR CERTAIN PERSONNEL REQUIRED.  (a)  In this section, "preauthorization" means the provision of a reliable representation to a physician or health care provider of whether a health benefit plan issuer will pay the physician or provider for proposed medical or health care services if the physician or provider provides those services to the patient for whom the services are proposed.  The term includes precertification, certification, recertification, or any other activity that involves providing a reliable representation by the issuer to a physician or health care provider.(b)  The commissioner by rule shall require a health benefit plan issuer to provide adequate training to personnel responsible for preauthorization of coverage or utilization review under the plan.  The purpose of the training is to prevent denial of coverage in violation of Section 1352.003 and to avoid confusion of medical benefits with mental health benefits.  The commissioner shall prescribe by rule the basic requirements for the training described by this subsection.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 4, eff. September 1, 2007.Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.38, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.35, eff. January 1, 2016.|
TX Ins Code § 1352.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1352 - Brain Injury|Section 1352.005. Notice to Insureds and Enrollees

Sec. 1352.005.  NOTICE TO INSUREDS AND ENROLLEES.  (a)  A health benefit plan issuer subject to this chapter, other than a small employer health benefit plan issuer, must annually notify each insured or enrollee under the plan in writing about the  coverages described by Section 1352.003.(b)  The commissioner shall prescribe by rule the specific contents and wording of the notice required under this section.(c)  The notice required under this section must include:(1)  a description of the benefits listed under Section 1352.003;(2)  a statement that the fact that an acquired brain injury does not result in hospitalization or receipt of a specific treatment or service described by Section 1352.003 for acute care treatment does not affect the right of the insured or enrollee  to receive benefits described by Section 1352.003 commensurate with the condition of the insured or enrollee; and(3)  a statement of the fact that benefits described by Section 1352.003 may be provided in a facility listed in Section 1352.007.|Added by Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 5, eff. September 1, 2007.Amended by: Acts 2015, 84th Leg., R.S., Ch. 837 (S.B. 200), Sec. 3.39, eff. January 1, 2016.Acts 2015, 84th Leg., R.S., Ch. 946 (S.B. 277), Sec. 2.36, eff. January 1, 2016.|