reglab/housing_qa huggingface dataset:
TX Ins Code § 1352.006 (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 1352.006. Determination of Medical Necessity; Extension of Coverage

Sec. 1352.006.  DETERMINATION OF MEDICAL NECESSITY; EXTENSION OF COVERAGE.  (a)  In this section, "utilization review" has the meaning assigned by Section 4201.002.(b)  Notwithstanding Chapter 4201 or any other law relating to the determination of medical necessity under this code, a health benefit plan shall respond to a person requesting utilization review or appealing for an extension of coverage based on an allegation of medical necessity not later than three business days after the date on which the person makes the request or submits the appeal.  The person must make the request or submit the appeal in the manner prescribed by the terms of the plan's health insurance policy or agreement, contract, evidence of coverage, or similar coverage document.  To comply with the requirements of this section, the health benefit plan issuer must respond through a direct telephone contact made by a representative of the issuer.  This subsection does not apply to a small employer health benefit plan.|Added by Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 5, eff. September 1, 2007.|
TX Ins Code § 1352.007 (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 1352.007. Treatment Facilities

Sec. 1352.007.  TREATMENT FACILITIES.  (a)  A health benefit plan may not deny coverage under this chapter based solely on the fact that the treatment or services are provided at a facility other than a hospital.  Treatment for an acquired brain injury may be provided under the coverage required by this chapter, as appropriate, at a facility at which appropriate services may be provided, including:(1)  a hospital regulated under Chapter 241, Health and Safety Code, including an acute or post-acute rehabilitation hospital; and(2)  an assisted living facility regulated under Chapter 247, Health and Safety Code.(b)  This section does not apply to a small employer health benefit plan.(c)  The issuer of a health benefit plan, including a preferred provider benefit plan or health maintenance organization plan, that contracts with or approves admission to a service provider under this chapter may not, solely because a facility is licensed by this state as an assisted living facility, refuse to contract with or approve admission to that facility to provide services that are:(1)  required under this chapter;(2)  within the scope of the license of an assisted living facility; and(3)  within the scope of the services provided under a CARF-accredited rehabilitation program for brain injury or another nationally recognized accredited rehabilitation program for brain injury.(d)  The issuer of a health benefit plan that requires or encourages insureds or enrollees to use health care providers designated by the plan shall ensure that the services required by this chapter that are within the scope of the license of an assisted living facility and that may be provided under a program described by Subsection (c)(3) are made available and accessible to the insureds or enrollees at an adequate number of assisted living facilities.(e)  A health benefit plan may not treat care provided in accordance with this chapter as custodial care solely because it is provided by an assisted living facility if the facility holds a CARF accreditation or other nationally recognized accreditation for a rehabilitation program for brain injury.(f)  To ensure the health and safety of insureds and enrollees, the commissioner may require that a licensed assisted living facility that provides covered post-acute care other than custodial care under this chapter to an insured or enrollee with acquired brain injury hold a CARF accreditation or other nationally recognized accreditation for a rehabilitation program for brain injury.|Added by Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 5, eff. September 1, 2007.Amended by: Acts 2013, 83rd Leg., R.S., Ch. 370 (H.B. 2929), Sec. 5, eff. September 1, 2013.|
TX Ins Code § 1352.008 (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 1352.008. Consumer Information

Sec. 1352.008.  CONSUMER INFORMATION.  The commissioner shall prepare information for use by consumers, purchasers of health benefit plan coverage, and self-insurers regarding coverages recommended for acquired brain injuries.  The department shall publish information prepared under this section on the department's Internet website.|Added by Acts 2007, 80th Leg., R.S., Ch. 877 (H.B. 1919), Sec. 5, eff. September 1, 2007.|
TX Ins Code § 1353.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1353 - Immunization or Vaccination Protocols Under Managed Care Plans|Section 1353.001. Prohibited Conduct

Sec. 1353.001.  PROHIBITED CONDUCT.  A managed care entity may not:(1)  require a physician participating in a managed care plan to issue an immunization or vaccination protocol for an immunization or vaccination to be administered to an enrollee in the plan;(2)  limit an enrollee's benefits for immunizations or vaccinations to circumstances in which an immunization or vaccination protocol is issued;(3)  provide a financial incentive to a physician to issue an immunization or vaccination protocol;  or(4)  impose a financial or other penalty on a physician who refuses to issue an immunization or vaccination protocol.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1353.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1353 - Immunization or Vaccination Protocols Under Managed Care Plans|Section 1353.002. Rules

Sec. 1353.002.  RULES.  The commissioner may adopt rules to implement this chapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1354.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1354 - Eligibility for Benefits for Alzheimer's Disease|Section 1354.001. Applicability of Chapter

Sec. 1354.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to a health benefit plan that:(1)  provides coverage for Alzheimer's disease;  and(2)  is an individual or group policy, contract, certificate, or evidence of coverage that is delivered or issued for delivery in this state by an insurer or a group hospital service corporation operating under Chapter 842.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1354.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1354 - Eligibility for Benefits for Alzheimer's Disease|Section 1354.002. Proof of Organic Disease

Sec. 1354.002.  PROOF OF ORGANIC DISEASE.  If a health benefit plan requires demonstrable proof of organic disease or other proof before the health benefit plan issuer will authorize payment of benefits for Alzheimer's disease, that proof requirement is satisfied by a clinical diagnosis of Alzheimer's disease made by a physician licensed in this state, including a history and physical, neurological, and psychological or psychiatric evaluations, and laboratory studies.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1356.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1356 - Mammography and Other Breast Imaging|Section 1356.001. Definitions

Sec. 1356.001.  DEFINITIONS.  In this chapter:(1)  "Breast tomosynthesis" means a radiologic mammography procedure that involves the acquisition of projection images over a stationary breast to produce cross-sectional digital three-dimensional images of the breast from which applicable breast cancer screening diagnoses may be determined.(1-a)  "Diagnostic imaging" means an imaging examination using mammography, ultrasound imaging, or magnetic resonance imaging that is designed to evaluate:(A)  a subjective or objective abnormality detected by a physician or patient in a breast;(B)  an abnormality seen by a physician on a screening mammogram;(C)  an abnormality previously identified by a physician as probably benign in a breast for which follow-up imaging is recommended by a physician; or(D)  an individual with a personal history of breast cancer or dense breast tissue.(2)  "Low-dose mammography" means:(A)  the x-ray examination of the breast using equipment dedicated specifically for mammography, including an x-ray tube, filter, compression device, and screens, with an average radiation exposure delivery of less than one rad mid-breast and with two views for each breast;(B)  digital mammography; or(C)  breast tomosynthesis.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2017, 85th Leg., R.S., Ch. 816 (H.B. 1036), Sec. 2, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1356 (H.B. 170), Sec. 1, eff. September 1, 2019.Acts 2021, 87th Leg., R.S., Ch. 867 (S.B. 1065), Sec. 2, eff. September 1, 2021.|
TX Ins Code § 1356.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1356 - Mammography and Other Breast Imaging|Section 1356.003. Applicability of General Provisions of Other Law

Sec. 1356.003.  APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW.  The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, 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 § 1356.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1356 - Mammography and Other Breast Imaging|Section 1356.004. Exception

Sec. 1356.004.  EXCEPTION.  This chapter does not apply to a plan that provides coverage only for a specified disease or for another limited benefit.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1356.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1356 - Mammography and Other Breast Imaging|Section 1356.005. Coverage Required

Sec. 1356.005.  COVERAGE REQUIRED.  (a)  A health benefit plan that provides coverage to a female who is 35 years of age or older must include coverage for an annual screening by all forms of low-dose mammography for the presence of occult breast cancer.(a-1)  A health benefit plan that provides coverage for a screening mammogram must provide coverage for diagnostic imaging that is no less favorable than the coverage for a screening mammogram.(b)  Coverage required by this section:(1)  may not be less favorable than coverage for other radiological examinations under the plan;  and(2)  must be subject to the same dollar limits, deductibles, and coinsurance factors as coverage for other radiological examinations under the plan.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2017, 85th Leg., R.S., Ch. 816 (H.B. 1036), Sec. 4, eff. September 1, 2017.Acts 2019, 86th Leg., R.S., Ch. 1356 (H.B. 170), Sec. 3, eff. September 1, 2019.Acts 2021, 87th Leg., R.S., Ch. 867 (S.B. 1065), Sec. 3, eff. September 1, 2021.|
TX Ins Code § 1359.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1359 - Formulas for Individuals With Phenylketonuria or Other Heritable Diseases|Section 1359.001. Definitions

Sec. 1359.001.  DEFINITIONS.  In this chapter:(1)  "Heritable disease" means an inherited disease that may result in mental or physical retardation or death.(2)  "Phenylketonuria" means an inherited condition that, if not treated, may cause severe mental retardation.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1359.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1359 - Formulas for Individuals With Phenylketonuria or Other Heritable Diseases|Section 1359.002. Applicability of Chapter

Sec. 1359.002.  APPLICABILITY OF CHAPTER.  This chapter applies only to a group health benefit plan that is a group policy, contract, or certificate of health insurance or an evidence of coverage delivered, issued for delivery, or renewed in this state by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;  or(3)  a health maintenance organization operating under Chapter 843.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1359.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1359 - Formulas for Individuals With Phenylketonuria or Other Heritable Diseases|Section 1359.003. Coverage Required

Sec. 1359.003.  COVERAGE REQUIRED.  (a)  A group health benefit plan must provide coverage for formulas necessary to treat phenylketonuria or a heritable disease.(b)  The group health benefit plan must provide the coverage to the same extent that the plan provides coverage for drugs that are available only on the orders of a physician.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1360.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1360 - Diagnosis and Treatment Affecting Temporomandibular Joint|Section 1360.001. Definition

Sec. 1360.001.  DEFINITION.  In this chapter, "temporomandibular joint" includes the jaw and the craniomandibular joint.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1360.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1360 - Diagnosis and Treatment Affecting Temporomandibular Joint|Section 1360.002. Applicability of Chapter

Sec. 1360.002.  APPLICABILITY OF CHAPTER.  This chapter applies only to a group health benefit plan delivered or issued for delivery in this state that:(1)  provides benefits for dental, medical, or surgical expenses incurred as a result of a health condition, accident, or sickness, including:(A)  a group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or a group evidence of coverage that is offered by:(i)  an insurance company;(ii)  a group hospital service corporation operating under Chapter 842;(iii)  a fraternal benefit society operating under Chapter 885;(iv)  a stipulated premium company operating under Chapter 884;  or(v)  a health maintenance organization operating under Chapter 843;  and(B)  to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:(i)  a multiple employer welfare arrangement as defined by Section 3 of that Act;(ii)  an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis;  or(iii)  another analogous benefit arrangement;  or(2)  is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1360.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1360 - Diagnosis and Treatment Affecting Temporomandibular Joint|Section 1360.003. Exception

Sec. 1360.003.  EXCEPTION.  This chapter does not apply to:(1)  a plan that provides coverage:(A)  only for a specified disease or another limited benefit;(B)  only for accidental death or dismemberment;(C)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(D)  as a supplement to a liability insurance policy;(E)  for credit insurance;(F)  only for vision care;  or(G)  only for indemnity for hospital confinement;(2)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);(3)  a workers' compensation insurance policy;(4)  a small employer health benefit plan written under Chapter 1501;(5)  medical payment insurance coverage provided under a motor vehicle insurance policy;  or(6)  a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1360.002.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1360.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1360 - Diagnosis and Treatment Affecting Temporomandibular Joint|Section 1360.004. Coverage Required

Sec. 1360.004.  COVERAGE REQUIRED.  (a)  A health benefit plan that provides coverage for medically necessary diagnostic or surgical treatment of conditions affecting skeletal joints must provide comparable coverage for diagnostic or surgical treatment of conditions affecting the temporomandibular joint if the treatment is medically necessary as a result of:(1)  an accident;(2)  a trauma;(3)  a congenital defect;(4)  a developmental defect;  or(5)  a pathology.(b)  Coverage required under this section may be subject to any provision in the health benefit plan that is generally applicable to surgical treatment, including a requirement for precertification of coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1360.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1360 - Diagnosis and Treatment Affecting Temporomandibular Joint|Section 1360.005. Dental Services Coverage Not Required

Sec. 1360.005.  DENTAL SERVICES COVERAGE NOT REQUIRED.  (a)  This chapter does not require a health benefit plan to provide coverage for dental services if dental services are not otherwise scheduled or provided as part of the coverage provided under the plan.(b)  A health benefit plan may not exclude from coverage under the plan an individual who is unable to undergo dental treatment in an office setting or under local anesthesia due to a documented physical, mental, or medical reason as determined by the individual's physician or by the dentist providing the dental care.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1361.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1361 - Detection and Prevention of Osteoporosis|Section 1361.001. Definition

Sec. 1361.001.  DEFINITION.  In this chapter, "qualified enrollee" means an individual entitled to coverage under a group health benefit plan who is:(1)  a postmenopausal woman who is not receiving estrogen replacement therapy;(2)  an individual with:(A)  vertebral abnormalities;(B)  primary hyperparathyroidism;  or(C)  a history of bone fractures;  or(3)  an individual who is:(A)  receiving long-term glucocorticoid therapy;  or(B)  being monitored to assess the response to or efficacy of an approved osteoporosis drug therapy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1361.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1361 - Detection and Prevention of Osteoporosis|Section 1361.002. Applicability of Chapter

Sec. 1361.002.  APPLICABILITY OF CHAPTER.  This chapter applies only to a group health benefit plan delivered, issued for delivery, or renewed in this state that provides coverage for medical or surgical expenses incurred as a result of accident or sickness, including:(1)  a group insurance policy;(2)  a group contract issued by a group hospital service corporation operating under Chapter 842;  and(3)  a group contract issued by a health maintenance organization operating under Chapter 843.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1361.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1361 - Detection and Prevention of Osteoporosis|Section 1361.003. Coverage Required

Sec. 1361.003.  COVERAGE REQUIRED.  A group health benefit plan must provide to a qualified enrollee coverage for medically accepted bone mass measurement to detect low bone mass and to determine the enrollee's risk of osteoporosis and fractures associated with osteoporosis.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1362.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1362 - Certain Tests for Detection of Prostate Cancer|Section 1362.001. Applicability of Chapter

Sec. 1362.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to a health benefit plan that:(1)  provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:(A)  an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage that is offered by:(i)  an insurance company;(ii)  a group hospital service corporation operating under Chapter 842;(iii)  a fraternal benefit society operating under Chapter 885;(iv)  a stipulated premium company operating under Chapter 884;  or(v)  a health maintenance organization operating under Chapter 843;  and(B)  to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:(i)  a multiple employer welfare arrangement as defined by Section 3 of that Act;  or(ii)  another analogous benefit arrangement;(2)  is offered by:(A)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;  or(B)  an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis;  or(3)  provides health and accident coverage through a risk pool created under Chapter 172, Local Government Code, notwithstanding Section 172.014, Local Government Code, or any other law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|