reglab/housing_qa huggingface dataset:
TX Ins Code § 1251.112 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter C. Group Accident and Health Insurance: Required Provisions|Section 1251.112. Deadline for Claim

Sec. 1251.112.  DEADLINE FOR CLAIM.  (a)  A group accident and health insurance policy must provide that:(1)  in the case of a claim for a loss other than a claim for a loss of time for disability, written proof of the loss must be provided to the insurer not later than the 90th day after the date of the loss;  and(2)  in the case of a claim for loss of time for disability:(A)  written proof of the loss must be provided to the insurer not later than the 90th day after the beginning of the period for which the insurer is liable;  and(B)  subsequent written proofs of the continuance of the disability must be provided to the insurer at intervals as reasonably required by the insurer.(b)  Failure to provide written proof of a loss within the time prescribed by Subsection (a) does not invalidate or reduce a claim if:(1)  it was not reasonably possible to provide written proof of the loss within that time;(2)  written proof of the loss is provided as soon as reasonably possible;  and(3)  unless the claimant does not have the legal capacity to provide proof of loss, proof of loss is provided not later than the first anniversary of the date the proof of loss is otherwise required.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.113 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter C. Group Accident and Health Insurance: Required Provisions|Section 1251.113. Prompt Payment of Benefits Required

Sec. 1251.113.  PROMPT PAYMENT OF BENEFITS REQUIRED.  A group accident and health insurance policy must provide that:(1)  all benefits payable under the policy, other than benefits for loss of time, must be paid not later than the 60th day after the date the proof of loss is received;  and(2)  subject to written proof of loss, all accrued benefits payable under the policy for loss of time must be paid at least monthly during the period for which the insurer is liable, and that any balance remaining unpaid at the end of that period must be paid as soon as possible after the proof of loss is received.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.114 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter C. Group Accident and Health Insurance: Required Provisions|Section 1251.114. Payment of Benefits

Sec. 1251.114.  PAYMENT OF BENEFITS.  (a)  A group accident and health insurance policy must provide that all benefits of the policy, other than benefits for loss of life, must be paid to the insured or the insured's assignee.(b)  A group accident and health insurance policy must provide that, subject to the provisions of the policy, benefits for loss of life of an insured must be paid to:(1)  the beneficiary designated by the insured or the beneficiary's assignee;(2)  the family member specified by the policy terms, if the policy contains conditions relating to family status;  or(3)  the estate of the insured, if the designated or specified beneficiary is not living at the time the insured dies.(c)  A group accident and health insurance policy may provide that if any benefits are payable to the estate of an individual or to an individual who is a minor or is otherwise not competent to give a valid release, the insurer may pay the benefits, up to an amount established by the commissioner, to any individual related by consanguinity or affinity to the individual who is considered by the insurer to be equitably entitled to the benefits.(d)  This section does not apply to:(1)  a credit accident and health insurance policy;  or(2)  a group contract issued by a group hospital service corporation.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.115 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter C. Group Accident and Health Insurance: Required Provisions|Section 1251.115. Right to Conduct Physical Examination or Autopsy

Sec. 1251.115.  RIGHT TO CONDUCT PHYSICAL EXAMINATION OR AUTOPSY.  A group accident and health insurance policy must provide that the insurer has the right and opportunity to:(1)  conduct a physical examination of an individual for whom a claim is made when and as often as the insurer reasonably requires during the pendency of the claim under the policy;  and(2)  in the case of a death, require that an autopsy be conducted, unless the autopsy is prohibited by law.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.116 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter C. Group Accident and Health Insurance: Required Provisions|Section 1251.116. Legal or Equitable Actions; Limitations

Sec. 1251.116.  LEGAL OR EQUITABLE ACTIONS;  LIMITATIONS.  A group accident and health insurance policy must provide that an action at law or in equity may not be brought to recover on the policy:(1)  before the 61st day after the date written proof of loss is filed as required under the policy;  or(2)  after the third anniversary of the date on which written proof of loss is required under the policy to be filed.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.117 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter C. Group Accident and Health Insurance: Required Provisions|Section 1251.117. Continuation or Conversion of Coverage

Sec. 1251.117.  CONTINUATION OR CONVERSION OF COVERAGE.  (a)  A group accident and health insurance policy must describe the continuation of group coverage and any conversion coverage provided in accordance with Subchapter F.(b)  Subsection (a) does not apply to a credit accident and health insurance policy.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.151 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter D. Group Accident and Health Insurance: Coverage for Dependents|Section 1251.151. Coverage for Certain Grandchildren

Sec. 1251.151.  COVERAGE FOR CERTAIN GRANDCHILDREN.  (a)  A group policy or contract of insurance for hospital, surgical, or medical expenses incurred as a result of accident or sickness, including a group contract issued by a group hospital service corporation, that provides coverage under the policy or contract for a child of an insured must, on payment of a premium, provide coverage for any grandchild of the insured if the grandchild is:(1)  unmarried;(2)  younger than 25 years of age;  and(3)  a dependent of the insured for federal income tax purposes at the time the application for coverage of the grandchild is made.(b)  Coverage for a grandchild of the insured under this section may not be terminated solely because the covered grandchild is no longer a dependent of the insured for federal income tax purposes.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.152 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter D. Group Accident and Health Insurance: Coverage for Dependents|Section 1251.152. Optional Coverage for Spouses and Dependents

Sec. 1251.152.  OPTIONAL COVERAGE FOR SPOUSES AND DEPENDENTS.  (a)  For purposes of this section, "dependent" includes:(1)  a child of an employee or member who is:(A)  unmarried;  and(B)  younger than 25 years of age;  and(2)  a grandchild of an employee or member who is:(A)  unmarried;(B)  younger than 25 years of age;  and(C)  a dependent of the insured for federal income tax purposes at the time the application for coverage of the grandchild is made.(b)  A group accident and health insurance policy may provide coverage for the spouse or a dependent of an employee or member.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.153 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter D. Group Accident and Health Insurance: Coverage for Dependents|Section 1251.153. Optional Continuation of Dependents' Benefits on Death of Insured

Sec. 1251.153.  OPTIONAL CONTINUATION OF DEPENDENTS' BENEFITS ON DEATH OF INSURED.  (a)  A group accident and health insurance policy that provides for the payment by the insurer of benefits for members of the family or dependents of an insured may provide for a continuation of all or part of those benefits after the death of the insured.(b)  Insurance provided by benefits described by Subsection (a) is not life insurance under Title 7.(c)  Coverage described by Subsection (a) may continue for any period subject to any other policy provisions relating to the termination of a dependent's coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.154 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter D. Group Accident and Health Insurance: Coverage for Dependents|Section 1251.154. Coverage for Adopted Children

Sec. 1251.154.  COVERAGE FOR ADOPTED CHILDREN.  A group policy or contract of insurance for hospital, surgical, or medical expenses incurred as a result of accident or sickness, including a group contract issued by a group hospital service corporation, that provides coverage for the immediate family or a child of an insured may not exclude from coverage or limit coverage of a child of the insured solely because the child is adopted.  A child is considered to be the child of an insured if the insured is a party to a suit in which the insured seeks to adopt the child.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.201 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter E. Group Accident and Health Insurance: General Provisions|Section 1251.201. Certificate of Insurance; Notice of Separate Available Coverage

Sec. 1251.201.  CERTIFICATE OF INSURANCE; NOTICE OF SEPARATE AVAILABLE COVERAGE.  (a)  An insurer issuing a group policy under this chapter shall provide to the policyholder for delivery to each employee or member of the insured group:(1)  a certificate of insurance that:(A)  summarizes the essential features of the insurance coverage of the employee or member, including the annual deductibles, annual and lifetime policy limits, and maximum out-of-pocket expenses under the policy; and(B)  states the person to whom benefits are payable; and(2)  a notice that informs the employee or member of the availability of and premiums for a rider or separate insurance policy that would provide coverage in addition to the coverage provided under the policy.(b)  If dependents are included in the coverage, an insurer is not required to provide more than one certificate or notice for each family unit.(c)  By agreement between the insurer and the policyholder, a certificate may be delivered electronically.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.030(a), eff. September 1, 2005.Acts 2005, 79th Leg., Ch. 939 (H.B. 765), Sec. 1, eff. September 1, 2005.|
TX Ins Code § 1251.202 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter E. Group Accident and Health Insurance: General Provisions|Section 1251.202. Notice Regarding Certain Employer Health Benefit Plans

Sec. 1251.202.  NOTICE REGARDING CERTAIN EMPLOYER HEALTH BENEFIT PLANS.  (a)  In this section, "standard health benefit plan" means a plan offered under Chapter 1507.(b)  If an employer offers to employees a standard health benefit plan, the employer shall:(1)  provide a copy of the disclosure statement provided to the employer by the plan issuer under Section 1507.006 or 1507.056 to:(A)  each employee:(i)  before the employee initially enrolls in the plan, unless the employee received notice under Paragraph (B) on or after the 90th day before the date the employee initially enrolls; and(ii)  not later than the 30th day before the date the employee renews enrollment in the plan; and(B)  each prospective employee before the prospective employee is hired by the employer; and(2)  obtain a copy of the notice signed by the employee or prospective employee at the time the notice is provided.|Added by Acts 2005, 79th Leg., Ch. 939 (H.B. 765), Sec. 2, eff. September 1, 2005.Amended by: Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.001, eff. April 1, 2009.|
TX Ins Code § 1251.251 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.251. Continuation of Group Coverage Required; Exception

Sec. 1251.251.  CONTINUATION OF GROUP COVERAGE REQUIRED;  EXCEPTION.  (a)  An insurer or group hospital service corporation that issues policies that provide hospital, surgical, or major medical expense insurance coverage or any combination of those coverages on an expense incurred basis shall, as required by this subchapter, provide continuation of group coverage for employees or members and their eligible dependents, subject to the eligibility provisions prescribed by Section 1251.252.(b)  This subchapter does not apply to an insurance policy that provides benefits only for expenses incurred because of a specified disease or an accident.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.252 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.252. Eligibility for Continuation of Group Coverage

Sec. 1251.252.  ELIGIBILITY FOR CONTINUATION OF GROUP COVERAGE.  (a)  An employee, member, or dependent is entitled to continuation of group coverage if:(1)  the individual's coverage under the group policy is terminated for any reason other than involuntary termination for cause, including discontinuance of the group policy in its entirety or with respect to an insured class;  and(2)  the individual has been continuously insured under the group policy, or under any group policy providing similar benefits that the policy replaces, for at least three consecutive months immediately before termination.(b)  For purposes of Subsection (a), involuntary termination for cause does not include termination for any health-related cause.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.253 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.253. Request for Continuation of Group Coverage

Sec. 1251.253.  REQUEST FOR CONTINUATION OF GROUP COVERAGE.  An employee, member, or dependent must provide to the employer or group policyholder a written request for continuation of group coverage not later than the 60th day after the later of:(1)  the date the group coverage would otherwise terminate; or(2)  the date the individual is given, in a format prescribed by the commissioner, notice by either the employer or the group policyholder of the right to continuation of group coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 550 (S.B. 1771), Sec. 2, eff. June 19, 2009.|
TX Ins Code § 1251.254 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.254. Payment of Contributions

Sec. 1251.254.  PAYMENT OF CONTRIBUTIONS.  Except as provided by this section, an employee, member, or dependent who elects to continue group coverage under this subchapter must pay to the employer or group policyholder each month the amount of contribution required by the employer or policyholder, plus two percent of the group rate for the coverage being continued under the group policy.  A payment under this section must be made not later than the 45th day after the date of the initial election for coverage and on the due date of each payment thereafter.  Following the first payment made after the initial election for coverage, the payment of any other premium shall be considered timely if made on or before the 30th day after the date on which the payment is due.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 550 (S.B. 1771), Sec. 3, eff. June 19, 2009.|
TX Ins Code § 1251.255 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.255. Termination of Continued Coverage

Sec. 1251.255.  TERMINATION OF CONTINUED COVERAGE.  (a)  Group coverage continued under this subchapter may not terminate until the earliest of:(1)  the date the maximum continuation period provided by law would end, which is:(A)  for any employee, member, or dependent not eligible for continuation coverage under Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) (COBRA), nine months after the date the employee, member, or dependent elects to continue the group coverage; or(B)  for any employee, member, or dependent eligible for continuation coverage under COBRA, six additional months following any period of continuation coverage provided under COBRA;(2)  the date failure to make timely payments would terminate the group coverage;(3)  the date the group coverage terminates in its entirety;(4)  the date the insured is or could be covered under Medicare;(5)  the date the insured is covered for similar benefits by another plan or program, including:(A)  a hospital, surgical, medical, or major medical expense insurance policy;(B)  a hospital or medical service subscriber contract; or(C)  a medical practice or other prepayment plan;(6)  the date the insured is eligible for similar benefits, whether or not covered for those benefits, under any arrangement of coverage for individuals in a group, whether on an insured or uninsured basis; or(7)  the date similar benefits are provided or available to the insured under any state or federal law other than continuation coverage under Title X, Consolidated Omnibus Budget Reconciliation Act of 1985 (29 U.S.C. Section 1161 et seq.) (COBRA).(b)  Repealed by Acts 2013, 83rd Leg., R.S., Ch. 615, Sec. 8(a)(3), eff. January 1, 2014.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.Amended by: Acts 2009, 81st Leg., R.S., Ch. 550 (S.B. 1771), Sec. 4, eff. June 19, 2009.Acts 2013, 83rd Leg., R.S., Ch. 615 (S.B. 1367), Sec. 8(a)(3), eff. January 1, 2014.|
TX Ins Code § 1251.256 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.256. Conversion of Group Policy

Sec. 1251.256.  CONVERSION OF GROUP POLICY.  (a)  An insurer may offer a conversion policy to each employee, member, or dependent who is covered under a group accident and health insurance policy that is terminating.(b)  If offered, an issuer shall issue a conversion policy without evidence of insurability if a written application for the policy and payment of the first premium are made not later than the 31st day after the date of termination.(c)  Any conversion policy must meet the minimum standards for benefits for conversion policies.(d)  The insurer may provide the conversion coverage on an individual or group basis.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.257 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.257. Premium for Converted Policy

Sec. 1251.257.  PREMIUM FOR CONVERTED POLICY.  (a)  An insurer shall determine the premium for a converted policy issued under this subchapter in accordance with the insurer's table of premium rates for coverage that was provided under the group policy.  The premium:(1)  must be based on the type of converted policy and the coverage provided by the policy;  and(2)  may be based on the age and geographic location of each individual to be covered.(b)  The premium for the same coverage and benefits under a converted policy may not exceed 200 percent of the premium determined for the group policy in accordance with Subsection (a).|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.258 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.258. Benefits Under Converted Policy

Sec. 1251.258.  BENEFITS UNDER CONVERTED POLICY.  The commissioner by rule shall establish minimum standards for benefits under converted policies issued under this subchapter.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|
TX Ins Code § 1251.259 (2021)
2021 Texas Statutes|Insurance Code|Title 8 - Health Insurance and Other Health Coverages|Subtitle B - Group Health Coverage|Chapter 1251 - Group and Blanket Health Insurance|Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy|Section 1251.259. Termination of Converted Policy

Sec. 1251.259.  TERMINATION OF CONVERTED POLICY.  Conversion coverage under this subchapter for an insured may not terminate until the earlier of:(1)  the date failure to make timely payments would terminate coverage;  or(2)  the date of an event specified by Section 1251.255(a)(4), (5), (6), or (7) for termination of continued group coverage.|Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.|