reglab/housing_qa huggingface dataset:
TX Ins Code § 1216.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1216 - Out-of-Country Coverage Prohibited|Section 1216.004. Out-of-Country Care Prohibited

Sec. 1216.004.  OUT-OF-COUNTRY CARE PROHIBITED.  A health benefit plan issuer may not issue or offer for sale in this state a health benefit plan that requires an enrollee to travel to a foreign country to receive a particular health care service under the health benefit plan.|Added by Acts 2007, 80th Leg., R.S., Ch. 1322 (S.B. 1391), Sec. 1, eff. September 1, 2007.Renumbered from Insurance Code, Section 1215.004 by Acts 2009, 81st Leg., R.S., Ch. 87 (S.B. 1969), Sec. 27.001(62), eff. September 1, 2009.|
TX Ins Code § 1217.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.001. Definitions

Sec. 1217.001.  DEFINITIONS.  In this chapter:(1)  "Health benefit plan issuer" means an entity authorized under this code or another insurance law of this state that delivers or issues for delivery a health benefit plan or other coverage that is covered under this chapter as described by Section 1217.002.  The term includes:(A)  an insurance company;(B)  a group hospital service corporation operating under Chapter 842;(C)  a fraternal benefit society operating under Chapter 885;(D)  a stipulated premium company operating under Chapter 884;(E)  a reciprocal exchange operating under Chapter 942;(F)  a health maintenance organization operating under Chapter 843;(G)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; or(H)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.(2)  "Health care services" includes medical or health care treatments, consultations, procedures, drugs, supplies, imaging and diagnostic services, inpatient and outpatient care, medical devices, and durable medical equipment.  The term does not include prescription drugs as defined by Section 551.003, Occupations Code.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1217.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.002. Applicability of Chapter

Sec. 1217.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or 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.(b)  This chapter applies to group health coverage made available by a school district in accordance with Section 22.004, Education Code.(c)  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.(d)  Notwithstanding any other law, this chapter applies to coverage under:(1)  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; and(2)  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 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1217.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.003. Exception

Sec. 1217.003.  EXCEPTION.  This chapter 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)  only 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, Social Security Act (42 U.S.C. Section 1395ss);(3)  medical payment insurance coverage provided under a motor vehicle insurance policy;(4)  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 1217.002; or(5)  a workers' compensation insurance policy.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1217.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.004. Standard Form

Sec. 1217.004.  STANDARD FORM.  (a)  The commissioner by rule shall:(1)  prescribe a single, standard form for requesting prior authorization of health care services;(2)  require a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers health care services benefits to use the form for any prior authorization required by the plan of health care services; and(3)  require that the department and a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers health care services benefits make the form available in paper form and electronically on the website of:(A)  the department;(B)  the health benefit plan issuer; and(C)  the agent of the health benefit plan issuer.(b)  Not later than the second anniversary of the date national standards for electronic prior authorization of benefits are adopted, a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers health care services benefits shall exchange prior authorization requests electronically with a physician or health care provider who has electronic capability and who initiates a request electronically.  For requests initiated on paper, a health benefit plan issuer or the agent of the health benefit plan issuer that manages or administers health care services benefits shall accept prior authorization requests using the standard paper form developed pursuant to this chapter.(c)  In prescribing a form under this section, the commissioner shall:(1)  develop the form with input from the advisory committee on uniform prior authorization forms for health care services benefits established under Section 1217.005; and(2)  take into consideration:(A)  any form for requesting prior authorization of health care services benefits that is widely used in this state or any form currently used by the department;(B)  request forms for prior authorization of health care services benefits established by the federal Centers for Medicare and Medicaid Services; and(C)  national standards, or draft standards, pertaining to electronic prior authorization of benefits.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1217.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.005. Advisory Committee on Uniform Prior Authorization Forms

Sec. 1217.005.  ADVISORY COMMITTEE ON UNIFORM PRIOR AUTHORIZATION FORMS.  (a)  The commissioner shall appoint a committee to advise the commissioner on the technical, operational, and practical aspects of developing the single, standard prior authorization form required under Section 1217.004 for requesting prior authorization of health care services, including:(1)  requirements for the health benefit plan issuer or agent of the health benefit plan issuer to acknowledge receipt of the standard form;(2)  timelines under which the health benefit plan issuer or agent of the health benefit plan issuer must acknowledge receipt of the standard form; and(3)  implications, including administrative penalties, for the failure of a health benefit plan issuer or agent of a health benefit plan issuer to:(A)  timely acknowledge receipt of the standard form; or(B)  use or accept the form.(b)  The commissioner shall consult the advisory committee with respect to any rule relating to a subject described by Section 1217.004 before adopting the rule and may consult the committee as needed with respect to a subsequent amendment of an adopted rule.(c)  The advisory committee shall be composed of an equal number of members from each of the following groups of stakeholders:(1)  physicians;(2)  health care providers other than physicians;(3)  hospitals;(4)  representatives of health benefit plans; and(5)  Health and Human Services Commission representatives.(d)  A physician may not serve on the advisory committee as a physician member under Subsection (c)(1) if the physician is or has been employed by or consults or has consulted for an insurance company.(e)  A member of the advisory committee serves without compensation.(f)  Section 39.003(a) of this code and Chapter 2110, Government Code, do not apply to the advisory committee.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1217.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.006. Failure to Prescribe Standard Form

Sec. 1217.006.  FAILURE TO PRESCRIBE STANDARD FORM.  Nothing in this chapter may be construed as authorizing the commissioner to decline to prescribe the form required by Section 1217.004.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1217.007 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1217 - Standard Request Form for Prior Authorization of Health Care Services|Section 1217.007. Construction With Other Law

Sec. 1217.007.  CONSTRUCTION WITH OTHER LAW.  Nothing in this chapter may be construed as permitting a health benefit plan issuer or an agent of a health benefit plan issuer to require prior authorization of health care services benefits when otherwise prohibited by law.|Added by Acts 2013, 83rd Leg., R.S., Ch. 1198 (S.B. 1216), Sec. 1, eff. September 1, 2013.|
TX Ins Code § 1218.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1218 - Coverage for Elective Abortion; Prohibitions and Requirements|Section 1218.001. Definition

Sec. 1218.001.  DEFINITION.  In this chapter, "elective abortion" means an abortion, as defined by Section 245.002, Health and Safety Code, other than an abortion performed due to a medical emergency as defined by Section 171.002, Health and Safety Code.|Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 2, eff. December 1, 2017.|
TX Ins Code § 1218.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1218 - Coverage for Elective Abortion; Prohibitions and Requirements|Section 1218.002. Applicability of Chapter

Sec. 1218.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a fraternal benefit society operating under Chapter 885;(4)  a stipulated premium company operating under Chapter 884;(5)  an 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.(b)  This chapter applies to group health coverage made available by a school district in accordance with Section 22.004, Education Code.(c)  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.(d)  Notwithstanding Section 1501.251 or any other law, this chapter applies to coverage under a small or large employer health benefit plan subject to Chapter 1501.(e)  Notwithstanding Section 1507.003 or 1507.053 or any other law, this chapter applies to a standard health benefit plan provided under Chapter 1507.|Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 2, eff. December 1, 2017.|
TX Ins Code § 1218.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1218 - Coverage for Elective Abortion; Prohibitions and Requirements|Section 1218.003. Certain Coverage Not Affected

Sec. 1218.003.  CERTAIN COVERAGE NOT AFFECTED.  This chapter does not apply to health benefit plan coverage provided to an enrollee for any abortion other than an elective abortion as defined by Section 1218.001.|Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 2, eff. December 1, 2017.|
TX Ins Code § 1218.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1218 - Coverage for Elective Abortion; Prohibitions and Requirements|Section 1218.004. Coverage by Health Benefit Plan

Sec. 1218.004.  COVERAGE BY HEALTH BENEFIT PLAN.  A health benefit plan may provide coverage for elective abortion only if:(1)  the coverage is provided to an enrollee separately from other health benefit plan coverage offered by the health benefit plan issuer;(2)  the enrollee pays the premium for coverage for elective abortion separately from, and in addition to, the premium for other health benefit plan coverage, if any; and(3)  the enrollee provides a signature for coverage for elective abortion, separately and distinct from the signature required for other health benefit plan coverage, if any, provided to the enrollee by the health benefit plan issuer.|Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 2, eff. December 1, 2017.|
TX Ins Code § 1218.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1218 - Coverage for Elective Abortion; Prohibitions and Requirements|Section 1218.005. Calculation of Premium

Sec. 1218.005.  CALCULATION OF PREMIUM.  (a)  A health benefit plan issuer that provides coverage for elective abortion shall calculate the premium for the coverage so that the premium fully covers the estimated cost of elective abortion per enrollee, determined on an actuarial basis.(b)  In calculating a premium under Subsection (a), the health benefit plan issuer may not take into account any cost savings in other health benefit plan coverage offered by the health benefit plan issuer that is estimated to result from coverage for elective abortion.(c)  A health benefit plan issuer may not provide a premium discount to or reduce the premium for an enrollee for other health benefit plan coverage on the basis that the enrollee has coverage for elective abortion.|Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 2, eff. December 1, 2017.|
TX Ins Code § 1218.006 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1218 - Coverage for Elective Abortion; Prohibitions and Requirements|Section 1218.006. Notice by Issuer

Sec. 1218.006.  NOTICE BY ISSUER.  A health benefit plan issuer that provides coverage for elective abortion shall at the time of enrollment in other health benefit plan coverage provide each enrollee with a notice that:(1)  coverage for elective abortion is optional and separate from other health benefit plan coverage offered by the health benefit plan issuer;(2)  the premium cost for coverage for elective abortion is a premium paid separately from, and in addition to, the premium for other health benefit plan coverage offered by the health benefit plan issuer; and(3)  the enrollee may enroll in a health benefit plan without obtaining coverage for elective abortion.|Added by Acts 2017, 85th Leg., 1st C.S., Ch. 5 (H.B. 214), Sec. 2, eff. December 1, 2017.|
TX Ins Code § 1221.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1221 - Employer Contributions to Individual Health Insurance Policies|Section 1221.001. Rules; Employer Contributions

Sec. 1221.001.  RULES; EMPLOYER CONTRIBUTIONS.  The commissioner by rule, unless it would violate state or federal law, may develop procedures to allow an employer to make financial contributions to or premium payments for an employee or retiree's individual consumer directed health insurance policy in a manner that eliminates or minimizes the state or federal tax consequences, or provides positive state or federal tax consequences, to the employer.|Added by Acts 2011, 82nd Leg., R.S., Ch. 1067 (S.B. 859), Sec. 7, eff. June 17, 2011.|
TX Ins Code § 1222.0001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1222 - Preauthorization for Medical or Health Care Service|Section 1222.0001. Definitions

Sec. 1222.0001.  DEFINITIONS.  In this chapter:(1)  "Health benefit plan" means a plan to which this chapter applies under Section 1222.0002.(2)  "Health benefit plan issuer" means an entity authorized under this code or another insurance law of this state that provides health insurance or health benefits in this state.(3)  "Preauthorization" has the meaning assigned by Section 1301.001.|Added by Acts 2019, 86th Leg., R.S., Ch. 488 (H.B. 3041), Sec. 1, eff. September 1, 2019.|
TX Ins Code § 1222.0002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1222 - Preauthorization for Medical or Health Care Service|Section 1222.0002. Applicability of Chapter

Sec. 1222.0002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by:(1)  an insurance company;(2)  a group hospital service corporation operating under Chapter 842;(3)  a health maintenance organization operating under Chapter 843;(4)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;(5)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;(6)  a stipulated premium company operating under Chapter 884;(7)  a fraternal benefit society operating under Chapter 885;(8)  a Lloyd's plan operating under Chapter 941; or(9)  an exchange operating under Chapter 942.(b)  Notwithstanding any other law, this chapter applies to:(1)  a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;(2)  a standard health benefit plan issued under Chapter 1507;(3)  a basic coverage plan under Chapter 1551;(4)  a basic plan under Chapter 1575;(5)  a primary care coverage plan under Chapter 1579;(6)  a plan providing basic coverage under Chapter 1601;(7)  health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;(8)  group health coverage made available by a school district in accordance with Section 22.004, Education Code;(9)  the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;(10)  the child health plan program under Chapter 62, Health and Safety Code;(11)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and(12)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.|Added by Acts 2019, 86th Leg., R.S., Ch. 488 (H.B. 3041), Sec. 1, eff. September 1, 2019.|
TX Ins Code § 1222.0003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1222 - Preauthorization for Medical or Health Care Service|Section 1222.0003. Preauthorization Renewal Request

Sec. 1222.0003.  PREAUTHORIZATION RENEWAL REQUEST.  A health benefit plan issuer that requires preauthorization as a condition of payment for a medical or health care service shall provide a preauthorization renewal process that allows a renewal of an existing preauthorization to be requested by a physician or health care provider at least 60 days before the date the preauthorization expires.|Added by Acts 2019, 86th Leg., R.S., Ch. 488 (H.B. 3041), Sec. 1, eff. September 1, 2019.|
TX Ins Code § 1222.0004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle A - Health Coverage in General|Chapter 1222 - Preauthorization for Medical or Health Care Service|Section 1222.0004. Determination Required

Sec. 1222.0004.  DETERMINATION REQUIRED.  If a health benefit plan issuer receives a preauthorization renewal request before the existing preauthorization expires, the health benefit plan issuer shall, if practicable, review the request and issue a determination indicating whether the medical or health care service is preauthorized before the existing preauthorization expires.|Added by Acts 2019, 86th Leg., R.S., Ch. 488 (H.B. 3041), Sec. 1, eff. September 1, 2019.|