reglab/housing_qa huggingface dataset:
TX Ins Code § 1507.009 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter A. Consumer Choice of Benefits Health Insurance Plans|Section 1507.009. Rules

Sec. 1507.009.  RULES.  The commissioner shall adopt rules necessary to implement this subchapter.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.051. Purpose

Sec. 1507.051.  PURPOSE.  The legislature recognizes the need for individuals and employers in this state to have the opportunity to choose health maintenance organization plans that are more affordable and flexible than existing market health care plans offered by health maintenance organizations.  The legislature, therefore, seeks to increase the availability of health care plans by allowing health maintenance organizations authorized to operate health maintenance organizations in this state to issue group or individual evidences of coverage that, in whole or in part, do not offer or provide state-mandated health benefits.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.052. Definitions

Sec. 1507.052.  DEFINITIONS.  (a)  In this subchapter, "standard health benefit plan" means a group or individual evidence of coverage that, in whole or in part, does not offer or provide state-mandated health benefits but that provides creditable coverage as defined by Section 1205.004(a) or 1501.102(a).(b)  In this subchapter, terms defined by Section 843.002 have the meanings assigned by that section.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.053. State-Mandated Health Benefits

Sec. 1507.053.  STATE-MANDATED HEALTH BENEFITS.  (a)  For purposes of this subchapter, "state-mandated health benefits" means coverage required under this code or other laws of this state to be provided in an evidence of coverage that:(1)  includes coverage for specific health care services or benefits;(2)  places limitations or restrictions on deductibles, coinsurance, copayments, or any annual or lifetime maximum benefit amounts, including limitations provided in Section 1271.151; or(3)  includes a specific category of licensed health care practitioner from whom an enrollee is entitled to receive care.(b)  For purposes of this subchapter, "state-mandated health benefits" does not include coverage that is mandated by federal law or standard provisions or rights required under this code or other laws of this state to be provided in an evidence of coverage that are unrelated to a specific health illness, injury, or condition of an enrollee, including provisions related to:(1)  continuation of coverage under Subchapter G, Chapter 1251;(2)  termination of coverage under Sections 1202.051 and 1501.108;(3)  preexisting conditions under Subchapter D, Chapter 1201, and Sections 1501.102-1501.105;(4)  coverage of children, including newborn or adopted children, under:(A)  Chapter 1504;(B)  Chapter 1503;(C)  Section 1501.157;(D)  Section 1501.158; and(E)  Sections 1501.607-1501.609;(5)  services of providers under Section 843.304;(6)  coverage for serious mental health illness under Subchapter A, Chapter 1355; and(7)  coverage for cancer screenings under:(A)  Chapter 1356;(B)  Chapter 1362;(C)  Chapter 1363; and(D)  Chapter 1370.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.030(a), eff. September 1, 2007.Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.030(a), eff. September 1, 2007.|
TX Ins Code § 1507.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.054. Standard Health Benefit Plans Authorized

Sec. 1507.054.  STANDARD HEALTH BENEFIT PLANS AUTHORIZED.  A health maintenance organization authorized to issue an evidence of coverage in this state may offer one or more standard health benefit plans.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.055 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.055. Notice to Enrollees

Sec. 1507.055.  NOTICE TO ENROLLEES.  (a)  Each written application for enrollment in a standard health benefit plan must contain the following language at the beginning of the document in bold type:"You have the option to choose this Consumer Choice of Benefits Health Maintenance Organization health care plan that, either in whole or in part, does not provide state-mandated health benefits normally required in evidences of coverage in Texas.  This standard health benefit plan may provide a more affordable health plan for you, although, at the same time, it may provide you with fewer health plan benefits than those normally included as state-mandated health benefits in Texas.  If you choose this standard health benefit plan, please consult with your insurance agent to discover which state-mandated health benefits are excluded in this evidence of coverage."(b)  Each standard health benefit plan must contain the following language at the beginning of the document in bold type:"This Consumer Choice of Benefits Health Maintenance Organization health care plan, either in whole or in part, does not provide state-mandated health benefits normally required in evidences of coverage in Texas.  This standard health benefit plan may provide a more affordable health plan for you, although, at the same time, it may provide you with fewer health plan benefits than those normally included as state-mandated health benefits in Texas.  Please consult with your insurance agent to discover which state-mandated health benefits are excluded in this evidence of coverage."|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.056 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.056. Disclosure Statement

Sec. 1507.056.  DISCLOSURE STATEMENT.  (a)  A health maintenance organization providing a standard health benefit plan must provide a proposed contract holder or a contract holder with a written disclosure statement that:(1)  acknowledges that the standard health benefit plan being purchased does not provide some or all state-mandated health benefits;(2)  lists those state-mandated health benefits not included in the standard health benefit plan; and(3)  if the standard health benefit plan is issued to an individual certificate holder, provides a notice that purchase of the plan may limit the certificate holder's future coverage options in the event the certificate holder's health changes and needed benefits are not available under the standard health benefit plan.(b)  Each applicant for initial enrollment must sign the disclosure statement provided by the health maintenance organization under Subsection (a) and return the statement to the health maintenance organization.  Under a group evidence of coverage, the term "applicant" means the employer.(c)  A health maintenance organization must:(1)  retain the signed disclosure statement in the organization's records; and(2)  on request from the commissioner, provide the signed disclosure statement to the department.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.Amended by: Acts 2019, 86th Leg., R.S., Ch. 657 (S.B. 1852), Sec. 2, eff. September 1, 2019.|
TX Ins Code § 1507.057 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.057. Additional Evidences of Coverage

Sec. 1507.057.  ADDITIONAL EVIDENCES OF COVERAGE.  A health maintenance organization that offers one or more standard health benefit plans under this subchapter must also offer at least one evidence of coverage that provides state-mandated health benefits and is otherwise authorized by this code.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.058 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.058. Rates

Sec. 1507.058.  RATES.  A health maintenance organization shall file for informational purposes the rates to be used with a standard health benefit plan.  Nothing in this section shall be construed as granting the commissioner any power or authority to determine, fix, prescribe, or promulgate the rates to be charged for any evidence of coverage.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1507.059 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1507 - Consumer Choice of Benefits Plans|Subchapter B. Consumer Choice of Benefits Health Maintenance Organization Plans|Section 1507.059. Rules

Sec. 1507.059.  RULES.  The commissioner shall adopt rules necessary to implement this subchapter.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.|
TX Ins Code § 1508.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter A. General Provisions|Section 1508.001. Purpose

Sec. 1508.001.  PURPOSE.  (a)  The purposes of the Healthy Texas Program are to:(1)  provide access to quality small employer health benefit plans at an affordable price;(2)  encourage small employers to offer health benefit plan coverage to employees and the dependents of employees; and(3)  maximize reliance on proven managed care strategies and procedures.(b)  The Healthy Texas Program is not intended to diminish the availability of traditional small employer health benefit plan coverage under Chapter 1501.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter A. General Provisions|Section 1508.002. Definitions

Sec. 1508.002.  DEFINITIONS.  In this chapter:(1)  "Dependent" has the meaning assigned by Section 1501.002(2).(2)  "Eligible employee" has the meaning assigned by Section 1501.002(3).(3)  "Fund" means the healthy Texas small employer premium stabilization fund established under Subchapter F.(4)  "Health benefit plan" and "health benefit plan issuer" have the meanings assigned by Sections 1501.002(5) and 1501.002(6), respectively.(5)  "Program" means the Healthy Texas Program established under this chapter.(6)  "Qualifying health benefit plan" means a health benefit plan that provides benefits for health care services in the manner described by this chapter.(7)  "Small employer" has the meaning assigned by Section 1501.002(14).|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter A. General Provisions|Section 1508.003. Rules

Sec. 1508.003.  RULES.  The commissioner may adopt rules as necessary to implement this chapter.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.051 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter B. Employer Eligibility; Contributions|Section 1508.051. Employer Eligibility to Participate

Sec. 1508.051.  EMPLOYER ELIGIBILITY TO PARTICIPATE.  (a)  A small employer may participate in the program if:(1)  during the 12-month period immediately preceding the date of application for a qualifying health benefit plan, the small employer does not offer employees group health benefits on an expense-reimbursed or prepaid basis; and(2)  at least 30 percent of the small employer's eligible employees receive annual wages from the employer in an amount that is equal to or less than 300 percent of the poverty guidelines for an individual, as defined and updated annually by the United States Department of Health and Human Services.(b)  A small employer ceases to be eligible to participate in the program if any health benefit plan that provides employee benefits on an expense-reimbursed or prepaid basis, other than another qualifying health benefit plan, is purchased or otherwise takes effect after the purchase of a qualifying health benefit plan.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.052 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter B. Employer Eligibility; Contributions|Section 1508.052. Commissioner Adjustments Authorized

Sec. 1508.052.  COMMISSIONER ADJUSTMENTS AUTHORIZED.  (a)  The commissioner by rule may adjust the 12-month period described by Section 1508.051(a)(1) to an 18-month period if the commissioner determines that the 12-month period is insufficient to prevent inappropriate substitution of other health benefit plans for qualifying health benefit plan coverage under this chapter.(b)  The commissioner by rule may adjust the percentage of the poverty guidelines described by Section 1508.051(a)(2) to a higher or lower percentage if the commissioner determines that the adjustment is necessary to fulfill the purposes of this chapter.  An adjustment made by the commissioner under this subsection takes effect on the first July 1 following the adjustment.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.053 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter B. Employer Eligibility; Contributions|Section 1508.053. Minimum Employer Participation Requirements

Sec. 1508.053.  MINIMUM EMPLOYER PARTICIPATION REQUIREMENTS.  A small employer that meets the eligibility requirements described by Section 1508.051(a) may apply to purchase a qualifying health benefit plan if 60 percent or more of the employer's eligible employees elect to participate in the plan.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.054 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter B. Employer Eligibility; Contributions|Section 1508.054. Employer Contribution Requirements

Sec. 1508.054.  EMPLOYER CONTRIBUTION REQUIREMENTS.  (a)  A small employer that purchases a qualifying health benefit plan must:(1)  pay 50 percent or more of the premium for each employee covered under the qualifying health benefit plan;(2)  offer coverage to all eligible employees receiving annual wages from the employer in an amount described by Section 1508.051(a)(2) or 1508.052(b), as applicable; and(3)  contribute the same percentage of premium for each covered employee.(b)  A small employer that purchases a qualifying health benefit plan under the program may elect to pay, but is not required to pay, all or any portion of the premium paid for dependent coverage under the qualifying health benefit plan.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.101 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter C. Program Participation; Required Coverage and Benefits|Section 1508.101. Participating Plan Issuers

Sec. 1508.101.  PARTICIPATING PLAN ISSUERS.  (a)  Subject to Subsection (b), any health benefit plan issuer may participate in the program.(b)  The commissioner by rule may limit which health benefit plan issuers may participate in the program if the commissioner determines that the limitation is necessary to achieve the purposes of this chapter.(c)  If the commissioner limits participation in the program under Subsection (b), the commissioner shall contract on a competitive procurement basis with one or more health benefit plan issuers to provide qualifying health benefit plan coverage under the program.(d)  Nothing in this chapter prohibits a regional or local health care program described by Chapter 75, Health and Safety Code, from participating in the program.  The commissioner by rule shall establish participation requirements applicable to regional and local health care programs that consider the unique plan designs, benefit levels, and participation criteria of each program.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.102 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter C. Program Participation; Required Coverage and Benefits|Section 1508.102. Preexisting Condition Provision Required

Sec. 1508.102.  PREEXISTING CONDITION PROVISION REQUIRED.  A health benefit plan offered under the program must include a preexisting condition provision that meets the requirements described by Section 1501.102.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.103 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter C. Program Participation; Required Coverage and Benefits|Section 1508.103. Exception From Mandated Benefit Requirements

Sec. 1508.103.  EXCEPTION FROM MANDATED BENEFIT REQUIREMENTS.  Except as expressly provided by this chapter, a small employer health benefit plan issued under the program is not subject to a law of this state that requires coverage or the offer of coverage of a health care service or benefit.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|
TX Ins Code § 1508.104 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle G - Health Coverage Availability|Chapter 1508 - Healthy Texas Program|Subchapter C. Program Participation; Required Coverage and Benefits|Section 1508.104. Certain Coverage Prohibited or Required

Sec. 1508.104.  CERTAIN COVERAGE PROHIBITED OR REQUIRED.  (a)  A qualifying health benefit plan may only provide coverage for in-plan services and benefits, except for:(1)  emergency care; or(2)  other services not available through a plan provider.(b)  In-plan services and benefits provided under a qualifying health benefit plan must include the following:(1)  inpatient hospital services;(2)  outpatient hospital services;(3)  physician services; and(4)  prescription drug benefits.(c)  The commissioner may approve in-plan benefits other than those required under Subsection (b) or emergency care or other services not available through a plan provider if the commissioner determines the inclusion to be essential to achieve the purposes of this chapter.(d)  The commissioner may, with respect to the categories of services and benefits described by Subsections (b) and (c):(1)  prepare specifications for a coverage provided under this chapter;(2)  determine the methods and procedures of claims administration;(3)  establish procedures to decide contested cases arising from coverage provided under this chapter;(4)  study, on an ongoing basis, the operation of all coverages provided under this chapter, including gross and net costs, administration costs, benefits, utilization of benefits, and claims administration;(5)  administer the healthy Texas small employer premium stabilization fund established under Subchapter F;(6)  provide the beginning and ending dates of coverages for enrollees in a qualifying health benefit plan;(7)  develop basic group coverage plans applicable to all individuals eligible to participate in the program;(8)  provide for optional group coverage plans in addition to the basic group coverage plans described by Subdivision (7);(9)  provide, as determined to be appropriate by the commissioner, additional statewide optional coverage plans;(10)  develop specific health benefit plans that permit access to high-quality, cost-effective health care;(11)  design, implement, and monitor health benefit plan features intended to discourage excessive utilization, promote efficiency, and contain costs for qualifying health benefit plans;(12)  develop and refine, on an ongoing basis, a health benefit strategy for the program that is consistent with evolving benefits delivery systems;(13)  develop a funding strategy that efficiently uses employer contributions to achieve the purposes of this chapter; and(14)  modify the copayment and deductible amounts for prescription drug benefits under a qualifying health benefit plan, if the commissioner determines that the modification is necessary to achieve the purposes of this chapter.|Added by Acts 2009, 81st Leg., R.S., Ch. 721 (S.B. 78), Sec. 2.01, eff. September 1, 2009.|