reglab/housing_qa huggingface dataset:
TX Ins Code § 1367.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter D. Child Craniofacial Abnormalities|Section 1367.153. Reconstructive Surgery for Craniofacial Abnormalities; Definition Required

Sec. 1367.153.  RECONSTRUCTIVE SURGERY FOR CRANIOFACIAL ABNORMALITIES;  DEFINITION REQUIRED.  A health benefit plan that provides coverage for a child who is younger than 18 years of age must define "reconstructive surgery for craniofacial abnormalities" under the plan to mean surgery to improve the function of, or to attempt to create a normal appearance of, an abnormal structure caused by congenital defects, developmental deformities, trauma, tumors, infections, or disease.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1367.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter D. Child Craniofacial Abnormalities|Section 1367.154. Rules

Sec. 1367.154.  RULES.  The commissioner shall adopt rules necessary to administer this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1367.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.201. Definition

Sec. 1367.201.  DEFINITION.  In this subchapter, rehabilitative and habilitative therapies include:(1)  occupational therapy evaluations and services;(2)  physical therapy evaluations and services;(3)  speech therapy evaluations and services; and(4)  dietary or nutritional evaluations.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.202 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.202. Applicability of Subchapter

Sec. 1367.202.  APPLICABILITY OF SUBCHAPTER.  This subchapter 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 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:(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 health maintenance organization operating under Chapter 843; or(F)  a multiple employer welfare arrangement subject to regulation under Chapter 846;(2)  is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; 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 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.203 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.203. Exception

Sec. 1367.203.  EXCEPTION.  This subchapter does not apply to:(1)  a plan that provides coverage:(A)  only for a specified disease or for 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 dental or vision care; or(G)  only for indemnity for hospital confinement;(2)  a small employer health benefit plan written under Chapter 1501;(3)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);(4)  a workers' compensation insurance policy;(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 1367.202.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.204 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.204. Offer of Coverage Required

Sec. 1367.204.  OFFER OF COVERAGE REQUIRED.  (a)  A health benefit plan issuer must offer coverage that complies with this subchapter.(b)  The individual or group policy or contract holder may reject coverage required to be offered under this section.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.205 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.205. Coverage of Certain Therapies

Sec. 1367.205.  COVERAGE OF CERTAIN THERAPIES.  (a)  A health benefit plan that provides coverage for rehabilitative and habilitative therapies under this subchapter may not prohibit or restrict payment for covered services provided to a child and determined to be necessary to and provided in accordance with an individualized family service plan issued by the Interagency Council on Early Childhood Intervention under Chapter 73, Human Resources Code.(b)  Rehabilitative and habilitative therapies described by Subsection (a) must be covered in the amount, duration, scope, and service setting established in the child's individualized family service plan.(c)  A child is entitled to benefits under this subchapter if the child, as a result of the child's relationship to an insured or enrollee in a health benefit plan, would be entitled to coverage under an accident and health insurance policy under Section 1201.061, 1201.062, 1201.063, or 1201.064.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.206 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.206. Prohibited Actions

Sec. 1367.206.  PROHIBITED ACTIONS.  Under the coverage required to be offered under this subchapter, a health benefit plan issuer may not:(1)  apply the cost of rehabilitative and habilitative therapies described by Section 1367.205(a) to an annual or lifetime maximum plan benefit or similar provision under the plan; or(2)  use the cost of rehabilitative or habilitative therapies described by Section 1367.205(a) as the sole justification for:(A)  increasing plan premiums; or(B)  terminating the insured's or enrollee's participation in the plan.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.207 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter E. Developmental Delays|Section 1367.207. Rules

Sec. 1367.207.  RULES.  The commissioner may adopt rules necessary to implement this subchapter.|Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005.|
TX Ins Code § 1367.251 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter F. Hearing AIDS and Cochlear Implants|Section 1367.251. Applicability of Subchapter

Sec. 1367.251.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage provided through a health group cooperative under Subchapter B of that chapter, 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 Lloyd's plan operating under Chapter 941;(5)  a stipulated premium insurance company operating under Chapter 884;(6)  a reciprocal exchange operating under Chapter 942;(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)  This subchapter applies to coverage under a group health benefit plan described by Subsection (a) provided to a resident of this state, regardless of whether the group policy, agreement, or contract is delivered, issued for delivery, or renewed within or outside this state.(c)  This subchapter applies to a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.(d)  Notwithstanding Section 22.409, Business Organizations Code, or any other law, this subchapter applies to health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code.(e)  Notwithstanding Section 75.104, Health and Safety Code, or any other law, this subchapter applies to a regional or local health care program operated under that section.(f)  Notwithstanding any other law, a standard health benefit plan provided under Chapter 1507 must provide the coverage required by this subchapter.(g)  Notwithstanding any provision in Chapter 1551, 1575, 1579, or 1601 or any other law, this subchapter 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.|Added by Acts 2017, 85th Leg., R.S., Ch. 979 (H.B. 490), Sec. 1, eff. September 1, 2017.|
TX Ins Code § 1367.252 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter F. Hearing AIDS and Cochlear Implants|Section 1367.252. Exception

Sec. 1367.252.  EXCEPTION.  This subchapter does not apply to:(1)  a plan that provides coverage:(A)  for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(B)  as a supplement to a liability insurance policy;(C)  for credit insurance;(D)  only for dental or vision care;(E)  only for hospital expenses; or(F)  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)  medical payment insurance coverage provided under a motor vehicle insurance policy;(5)  a long-term care 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 1367.251; or(6)  the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code.|Added by Acts 2017, 85th Leg., R.S., Ch. 979 (H.B. 490), Sec. 1, eff. September 1, 2017.|
TX Ins Code § 1367.253 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1367 - Coverage of Children|Subchapter F. Hearing AIDS and Cochlear Implants|Section 1367.253. Coverage Required

Sec. 1367.253.  COVERAGE REQUIRED.  (a) A health benefit plan must provide coverage for the cost of a medically necessary hearing aid or cochlear implant and related services and supplies for a covered individual who is 18 years of age or younger.(b)  Coverage required under this section:(1)  must include:(A)  fitting and dispensing services and the provision of ear molds as necessary to maintain optimal fit of hearing aids;(B)  any treatment related to hearing aids and cochlear implants, including coverage for habilitation and rehabilitation as necessary for educational gain; and(C)  for a cochlear implant, an external speech processor and controller with necessary components replacement every three years; and(2)  is limited to:(A)  one hearing aid in each ear every three years; and(B)  one cochlear implant in each ear with internal replacement as medically or audiologically necessary.(c)  Except as provided by Subsections (b) and (d), coverage required under this section:(1)  may not be less favorable than coverage for physical illness generally under the plan; and(2)  must be subject to durational limits and coinsurance factors no less favorable than coverage provided for physical illness generally under the plan.(d)  Coverage required under this section is subject to any provision that applies generally to coverage provided for durable medical equipment benefits under the plan, including a provision relating to deductibles, coinsurance, or prior authorization.(e)  This section does not apply to a qualified health plan defined by 45 C.F.R. Section 155.20 if a determination is made under 45 C.F.R. Section 155.170 that:(1)  this subchapter requires the plan to offer benefits in addition to the essential health benefits required under 42 U.S.C. Section 18022(b); and(2)  this state must make payments to defray the cost of the additional benefits mandated by this subchapter.|Added by Acts 2017, 85th Leg., R.S., Ch. 979 (H.B. 490), Sec. 1, eff. September 1, 2017.|
TX Ins Code § 1369.001 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter A. Coverage of Prescription Drugs in General|Section 1369.001. Definitions

Sec. 1369.001.  DEFINITIONS.  In this subchapter:(1)  "Contraindication" means the potential for, or the occurrence of:(A)  an undesirable change in the therapeutic effect of a prescribed drug because of the presence of a disease condition in the patient for whom the drug is prescribed;  or(B)  a clinically significant adverse effect of a prescribed drug on a disease condition of the patient for whom the drug is prescribed.(2)  "Drug" has the meaning assigned by Section 551.003, Occupations Code.(2-a)  "Enrollee" means an individual who is covered under a health benefit plan, including a covered dependent.(3)  "Indication" means a symptom, cause, or occurrence in a disease that points out the cause, diagnosis, course of treatment, or prognosis of the disease.(4)  "Peer-reviewed medical literature" means scientific studies published in a peer-reviewed national professional journal.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2017, 85th Leg., R.S., Ch. 727 (S.B. 1076), Sec. 1, eff. September 1, 2017.|
TX Ins Code § 1369.002 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter A. Coverage of Prescription Drugs in General|Section 1369.002. Applicability of Subchapter

Sec. 1369.002.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or 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 health maintenance organization operating under Chapter 843;(7)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;  or(8)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.003 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter A. Coverage of Prescription Drugs in General|Section 1369.003. Exception

Sec. 1369.003.  EXCEPTION.  This subchapter does not apply to:(1)  a health benefit plan that provides coverage:(A)  only for a specified disease or for 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 dental or vision care;(G)  only for hospital expenses;  or(H)  only for indemnity for hospital confinement;(2)  a small employer health benefit plan written under Chapter 1501;(3)  a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), as amended;(4)  a workers' compensation insurance policy;(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 1369.002.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.004 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter A. Coverage of Prescription Drugs in General|Section 1369.004. Coverage Required

Sec. 1369.004.  COVERAGE REQUIRED.  (a)  A health benefit plan that covers drugs must cover any drug prescribed to treat an enrollee for a chronic, disabling, or life-threatening illness covered under the plan if the drug:(1)  has been approved by the United States Food and Drug Administration for at least one indication;  and(2)  is recognized by the following for treatment of the indication for which the drug is prescribed:(A)  a prescription drug reference compendium approved by the commissioner for purposes of this section;  or(B)  substantially accepted peer-reviewed medical literature.(b)  Coverage of a drug required under Subsection (a) must include coverage of medically necessary services associated with the administration of the drug.(c)  A health benefit plan issuer may not, based on a "medical necessity" requirement, deny coverage of a drug required under Subsection (a) unless the reason for the denial is unrelated to the legal status of the drug use.(d)  This section does not require a health benefit plan to cover:(1)  experimental drugs that are not otherwise approved for an indication by the United States Food and Drug Administration;(2)  any disease or condition that is excluded from coverage under the plan;  or(3)  a drug that the United States Food and Drug Administration has determined to be contraindicated for treatment of the current indication.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1369.0041 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter A. Coverage of Prescription Drugs in General|Section 1369.0041. Certain Payments and Refills

Sec. 1369.0041.  CERTAIN PAYMENTS AND REFILLS.  (a)  A health benefit plan issuer that covers prescription drugs may not require an enrollee to make a payment for a prescription drug at the point of sale in an amount greater than the lesser of:(1)  the applicable copayment;(2)  the allowable claim amount for the prescription drug; or(3)  the amount an individual would pay for the drug if the individual purchased the drug without using a health benefit plan or any other source of drug benefits or discounts.(b)  A health benefit plan that covers prescription eye drops to treat a chronic eye disease or condition must allow the refill of prescription eye drops if the enrollee timely pays at the point of sale the maximum amount allowed by Subsection (a) and:(1)  the original prescription states that additional quantities of the eye drops are needed; (2)  the refill does not exceed the total quantity of dosage units authorized by the prescribing provider on the original prescription, including refills; and (3)  the refill is dispensed on or before the last day of the prescribed dosage period and:(A)  not earlier than the 21st day after the date a prescription for a 30-day supply of eye drops is dispensed;(B)  not earlier than the 42nd day after the date a prescription for a 60-day supply of eye drops is dispensed; or(C)  not earlier than the 63rd day after the date a prescription for a 90-day supply of eye drops is dispensed.|Added by Acts 2017, 85th Leg., R.S., Ch. 727 (S.B. 1076), Sec. 2, eff. September 1, 2017.|
TX Ins Code § 1369.005 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle E - Benefits Payable Under Health Coverages|Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services|Subchapter A. Coverage of Prescription Drugs in General|Section 1369.005. Rules

Sec. 1369.005.  RULES.  The commissioner may adopt rules to implement this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|