reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.102. Applicability

Sec. 1651.102.  APPLICABILITY.  Except to the extent of a conflict, Subchapters A and B apply to a plan issued in accordance with this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.103. Assistance of Department

Sec. 1651.103.  ASSISTANCE OF DEPARTMENT.  The department shall assist the Health and Human Services Commission as necessary for the commission to perform its duties and functions with respect to the administration of the partnership for long-term care program.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.104. Long-Term Care Insurance Policy for Partnership for Long-Term Care Program

Sec. 1651.104.  LONG-TERM CARE INSURANCE POLICY FOR PARTNERSHIP FOR LONG-TERM CARE PROGRAM.  The commissioner, in consultation with the Health and Human Services Commission, shall adopt minimum standards for a long-term care benefit plan that may qualify as an approved plan under the partnership for long-term care program.  The standards must be consistent with provisions governing the expansion of a state long-term care partnership program established under the federal Deficit Reduction Act of 2005 (Pub. L. No. 109-171).
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.105. Required Training

Sec. 1651.105.  REQUIRED TRAINING.  (a)  Each individual who sells a long-term care benefit plan under the partnership for long-term care program must complete training and demonstrate evidence of an understanding of these plans and how the plans relate to other public and private coverage of long-term care.
(b)  Each long-term care benefit plan issuer that offers a plan under the partnership for long-term care program shall certify to the commissioner, in the form required by the commissioner, that each individual who sells the plan on behalf of the issuer complies with the requirements of this section.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.106. Effect of Discontinuation of Program on Policy

Sec. 1651.106.  EFFECT OF DISCONTINUATION OF PROGRAM ON POLICY.  If the partnership for long-term care program is discontinued, an individual who purchased an approved plan before the date the program is discontinued remains eligible to receive dollar-for-dollar asset disregard and asset protection under the medical assistance program.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1651 - Long-Term Care Benefit Plans › Subchapter C. Partnership for Long-Term Care Program › Section 1651.107. Rules

Sec. 1651.107.  RULES.  The commissioner may adopt rules as necessary to implement this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 795 (S.B. 22), Sec. 3, eff. March 1, 2008.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter A. General Provisions › Section 1652.001. Definitions

Sec. 1652.001.  DEFINITIONS.  In this chapter:
(1)  "Applicant" means:
(A)  an individual who seeks to contract for insurance or other health benefits under an individual Medicare supplement benefit plan;  or
(B)  the proposed certificate holder of a group Medicare supplement benefit plan.
(2)  "Approved regulatory program" means a state regulatory program that complies with the requirements of Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
(3)  "Medicare" means the Health Insurance for the Aged Act (42 U.S.C. Section 1395 et seq.), as amended.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter A. General Provisions › Section 1652.002. Medicare Supplement Benefit Plan

Sec. 1652.002.  MEDICARE SUPPLEMENT BENEFIT PLAN.  (a)  "Medicare supplement benefit plan" means a group or individual policy of accident and health insurance, a subscriber contract of a group hospital service corporation operating under Chapter 842, or, to the extent required by federal law, an evidence of coverage issued by a health maintenance organization operating under Chapter 843 that is advertised, marketed, or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical, or surgical expenses of an individual eligible for Medicare.
(b)  A policy, contract, subscriber contract, or evidence of coverage is not considered to be a Medicare supplement benefit plan if it is:
(1)  a policy, contract, subscriber contract, or evidence of coverage of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or a combination, for employees or former employees, or a combination, or for members or former members, or a combination, of the labor organizations;
(2)  a policy or health care benefit plan, including a policy or contract of group insurance, a group contract of a group hospital service corporation operating under Chapter 842, or a group evidence of coverage issued by a health maintenance organization operating under Chapter 843 that is not marketed or held to be a Medicare supplement benefit plan;  or
(3)  an individual or group evidence of coverage issued in accordance with a contract under Section 1833 or 1876, Social Security Act (42 U.S.C. Section 1395l or 1395mm), by a health maintenance organization operating under Chapter 843.
(c)  The commissioner by rule may modify the definition of "Medicare supplement benefit plan" provided by Subsection (a) to the extent necessary for this state to qualify as a state with an approved regulatory program.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter A. General Provisions › Section 1652.003. Applicability of Chapter

Sec. 1652.003.  APPLICABILITY OF CHAPTER.  This chapter applies to an individual or group Medicare supplement benefit plan delivered or issued for delivery in this state and, regardless of the place where the plan was delivered or issued for delivery, a certificate that was issued under a group Medicare supplement benefit plan and delivered or issued for delivery in this state, if the plan or certificate is issued by:
(1)  a capital stock insurance company, including a life, health and accident, and general casualty insurance company;
(2)  a mutual life insurance company;
(3)  a mutual assessment life insurance company, including a statewide mutual assessment company, local mutual aid association, and burial association;
(4)  a mutual or mutual assessment association of any kind, including an association subject to Section 887.102;
(5)  a mutual insurance company other than a life insurance company;
(6)  a mutual or natural premium life or casualty insurance company;
(7)  a fraternal benefit society;
(8)  a Lloyd's plan;
(9)  a reciprocal or interinsurance exchange;
(10)  a nonprofit hospital, medical, or dental service corporation, including a corporation operating under Chapter 842;
(11)  a stipulated premium company;
(12)  another insurer that by law is required to be authorized by the department;  or
(13)  a health maintenance organization operating under Chapter 843, to the extent required by federal law.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter A. General Provisions › Section 1652.004. Construction of Chapter

Sec. 1652.004.  CONSTRUCTION OF CHAPTER.  (a)  This chapter may not be construed to enlarge the powers of an entity described by Section 1652.003.
(b)  This chapter controls to the extent of any conflict with another provision of this code.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter A. General Provisions › Section 1652.005. Rules Necessary for Certification

Sec. 1652.005.  RULES NECESSARY FOR CERTIFICATION.  In addition to other rules required or authorized by this chapter, the commissioner shall adopt reasonable rules necessary and proper to carry out this chapter, including rules adopted in accordance with federal law relating to the regulation of Medicare supplement benefit plan coverage that are necessary for this state to obtain or retain certification as a state with an approved regulatory program.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.051. Minimum Standards

Sec. 1652.051.  MINIMUM STANDARDS.  (a)  The commissioner shall adopt reasonable rules to establish specific standards for provisions in Medicare supplement benefit plans and standards for facilitating comparisons of different Medicare supplement benefit plans.  The standards are in addition to and must be in accordance with:
(1)  applicable laws of this state, including Chapters 842 and 1201;
(2)  applicable federal law, rules, regulations, and standards;  and
(3)  any model rules and regulations required by federal law, including Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
(b)  The standards may include provisions relating to:
(1)  terms of renewability;
(2)  initial and subsequent conditions of eligibility;
(3)  nonduplication of coverage;
(4)  probationary periods;
(5)  benefit limitations, exceptions, and reductions;
(6)  elimination periods;
(7)  requirements for replacement;
(8)  recurrent conditions;
(9)  definitions of terms;  and
(10)  exclusions required by state or federal law.
(c)  The commissioner may adopt reasonable rules that specifically prohibit benefit plan provisions that:
(1)  are not otherwise specifically authorized by statute;  and
(2)  the commissioner determines are unjust, unfair, or unfairly discriminatory to a person who is covered or proposed for coverage.
(d)  Rules adopted under this section must include requirements that are at least equal to those required by federal law, rules, regulations, and standards, including Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.052. Minimum Standards for Benefits and Claim Payments

Sec. 1652.052.  MINIMUM STANDARDS FOR BENEFITS AND CLAIM PAYMENTS.  (a)  The commissioner shall adopt reasonable rules to establish minimum standards for benefits and claim payments under Medicare supplement benefit plans.
(b)  The standards for benefits and claim payments must include the requirements for certification of Medicare supplement benefit plans prescribed by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.053. Duplicate Benefits Prohibited

Sec. 1652.053.  DUPLICATE BENEFITS PROHIBITED.  A Medicare supplement benefit plan or certificate in force in this state may not contain benefits that duplicate benefits provided by Medicare.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.054. Basic Plan

Sec. 1652.054.  BASIC PLAN.  An entity described by Section 1652.003 that offers for sale in this state a Medicare supplement benefit plan must offer a basic Medicare supplement benefit plan that:
(1)  provides only those benefits common to all Medicare supplement benefit plans;  and
(2)  meets but does not exceed the minimum standards of benefits for Medicare supplement benefit plans adopted by the commissioner and authorized by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.055. Additional Benefits

Sec. 1652.055.  ADDITIONAL BENEFITS.  (a)  In addition to the basic Medicare supplement benefit plan described by Section 1652.054, an entity may offer additional Medicare supplement benefit plans for sale in this state.
(b)  The combination of benefits provided by an additional plan must conform to one of the benefit packages adopted by the commissioner and authorized by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
(c)  The commissioner by rule shall provide for the approval of new or innovative benefits that may be provided in a plan other than the basic plan and that otherwise comply with this subchapter.  The benefits must:
(1)  be offered in a manner consistent with the goal of Medicare supplement benefit plan simplification;  and
(2)  meet the requirements prescribed by Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.056. Coverage for Mammography

Sec. 1652.056.  COVERAGE FOR MAMMOGRAPHY.  (a)  In this section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast.
(b)  Each Medicare supplement benefit plan must include coverage for an annual screening by low-dose mammography for the presence of occult breast cancer.
(c)  The coverage for the annual screening may not be less favorable than coverage for other radiological examinations and must be subject to the same dollar limits, deductibles, and coinsurance factors.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.057. Waiver of Waiting Period

Sec. 1652.057.  WAIVER OF WAITING PERIOD.  (a)  An entity that delivers or issues for delivery in this state a Medicare supplement benefit plan or certificate that replaces a Medicare supplement benefit plan or certificate shall give credit for the satisfaction or partial satisfaction of any waiting period, elimination period, or probationary period for a preexisting condition that has been satisfied under the plan being replaced.
(b)  A replacement plan that clearly provides a new or additional benefit may include appropriate and clearly stated periods as a condition for payment of the new or additional benefit.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter B. Benefits › Section 1652.058. Coverage for Preexisting Condition

Sec. 1652.058.  COVERAGE FOR PREEXISTING CONDITION.  (a)  A Medicare supplement benefit plan may not contain a provision that excludes coverage for a claim for losses incurred more than six months after the effective date of coverage for a preexisting condition.
(b)  A Medicare supplement benefit plan may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter C. Loss Ratio Standards › Section 1652.101. Loss Ratio Standards

Sec. 1652.101.  LOSS RATIO STANDARDS.  (a)  A Medicare supplement benefit plan must return to a plan holder benefits that are reasonable in relation to the premium charged.
(b)  The commissioner shall adopt reasonable rules to establish minimum loss ratio standards for Medicare supplement benefit plans.  The standards must be established:
(1)  on the basis of incurred claims experience and earned premiums for the entire period for which rates are computed to provide coverage;
(2)  in accordance with accepted actuarial principles and practices;  and
(3)  to the extent necessary for the state to obtain or retain certification as a state with an approved regulatory program.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter C. Loss Ratio Standards › Section 1652.102. Filing Requirements

Sec. 1652.102.  FILING REQUIREMENTS.  (a)  Annually, each entity providing Medicare supplement benefit plans in this state shall file with the department the entity's rates, rating schedule, and supporting documentation demonstrating that:
(1)  the entity is complying with the applicable loss ratio standards of this state;  and
(2)  the actual and expected losses in relation to premiums comply with the requirements of this subchapter and the rules adopted by the commissioner.
(b)  The documentation required by Subsection (a) must include a report of the ratio of incurred losses to covered premiums for the preceding calendar year, illustrated by calendar year of issue.
(c)  The commissioner may adopt rules relating to filing requirements for rates, rating schedules, and loss ratios.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter C. Loss Ratio Standards › Section 1652.103. Review of Premium Increases

Sec. 1652.103.  REVIEW OF PREMIUM INCREASES.  (a)  The commissioner by rule shall provide a process for reviewing and approving or disapproving a proposed premium increase relating to a Medicare supplement benefit plan.
(b)  The rules must comply with federal law, including Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter C. Loss Ratio Standards › Section 1652.104. Benefit Changes

Sec. 1652.104.  BENEFIT CHANGES.  (a)  Before the date on which a Medicare benefit change required by federal law takes effect, each entity providing in this state a Medicare supplement benefit plan existing on the effective date of the change shall file with the commissioner, in accordance with Chapter 1701:
(1)  each appropriate premium adjustment necessary to produce the loss ratios originally anticipated for the applicable plan, accompanied by any supporting documents necessary to justify the adjustment;  and
(2)  each appropriate rider, endorsement, or plan form necessary to modify the coverage so as to eliminate benefit duplications with Medicare.
(b)  A rider, endorsement, or plan form required by Subsection (a) must provide a clear description of the Medicare supplement benefits provided by the plan.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter C. Loss Ratio Standards › Section 1652.105. Reporting Loss Ratio Information to Secretary of Health and Human Services

Sec. 1652.105.  REPORTING LOSS RATIO INFORMATION TO SECRETARY OF HEALTH AND HUMAN SERVICES.  To the extent necessary for this state to obtain or retain certification as a state with an approved regulatory program, the department shall comply with federal requirements relating to periodic reporting of loss ratio information to the secretary of health and human services, based on a uniform methodology, as authorized by federal law.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter D. Consumer Information and Notice › Section 1652.151. Rules Relating to Disclosure

Sec. 1652.151.  RULES RELATING TO DISCLOSURE.  The rules adopted under Sections 1652.152, 1652.153, and 1652.154 must include provisions and requirements that are at least equal to those required by federal law, including the rules, regulations, and standards adopted under Section 1882, Social Security Act (42 U.S.C. Section 1395ss).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter D. Consumer Information and Notice › Section 1652.152. Outline of Coverage

Sec. 1652.152.  OUTLINE OF COVERAGE.  (a)  To provide for full and fair disclosure in the sale of Medicare supplement benefit plans, a Medicare supplement benefit plan or certificate may not be delivered or issued for delivery in this state unless an outline of coverage that complies with this section is delivered to the applicant when the applicant applies for the coverage.
(b)  The commissioner by rule shall prescribe the format and content of the outline of coverage required by Subsection (a).  The rules must address the style, arrangement, and overall appearance of the outline of coverage, including the size, color, and prominence of type and the arrangement of text and captions.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter D. Consumer Information and Notice › Section 1652.153. Informational Brochure

Sec. 1652.153.  INFORMATIONAL BROCHURE.  (a)  The commissioner by rule may prescribe a standard form and the contents of an informational brochure intended to improve the ability of an individual eligible for Medicare to understand Medicare and to select the most appropriate Medicare supplement coverage.
(b)  Except as provided by Subsection (c), the commissioner by rule may require that the informational brochure be provided to an individual eligible for Medicare concurrently with delivery of the outline of coverage.
(c)  If the plan is a direct response Medicare supplement benefit plan, the commissioner by rule may require that the informational brochure be provided on request to an individual eligible for Medicare at any time not later than the time the plan is delivered.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter D. Consumer Information and Notice › Section 1652.154. Notice Relating to Other Types of Coverage

Sec. 1652.154.  NOTICE RELATING TO OTHER TYPES OF COVERAGE.  (a)  The commissioner may adopt reasonable rules for captions or notice requirements for each accident and health insurance policy, subscriber contract, or evidence of coverage sold to an individual eligible for Medicare that are determined to be in the public interest and designed to inform the individual that a particular coverage is not a Medicare supplement benefit plan.  This subsection does not apply to:
(1)  a Medicare supplement benefit plan;
(2)  a disability income policy;
(3)  a basic, catastrophic, or major medical expense policy;
(4)  a single premium nonrenewable policy;  or
(5)  another policy, contract, or subscriber contract described by Section 1652.002(b)(1) or (2).
(b)  The commissioner may adopt reasonable rules to govern the full and fair disclosure of information relating to replacing an accident and health insurance policy, a subscriber contract, or a certificate by an individual eligible for Medicare.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter D. Consumer Information and Notice › Section 1652.155. Right to Return for Refund; Notice

Sec. 1652.155.  RIGHT TO RETURN FOR REFUND;  NOTICE.  (a)  If an applicant is not satisfied for any reason after examining a Medicare supplement benefit plan document or certificate, the applicant is entitled to receive a refund of the premium if the applicant returns the document or certificate not later than the 30th day after the date it is delivered.
(b)  The entity issuing the plan or certificate shall refund the premium directly to the applicant in a timely manner.
(c)  A Medicare supplement benefit plan or certificate must have a notice stating the substance prescribed by Subsection (a) prominently printed on the first page of or attached to the plan or certificate.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter D. Consumer Information and Notice › Section 1652.156. Advertising Filing Requirements

Sec. 1652.156.  ADVERTISING FILING REQUIREMENTS.  (a)  The commissioner shall adopt reasonable rules to require each entity described by Section 1652.003 to file with the department a copy of any advertisement relating to Medicare supplement benefit plans that the entity intends to use in this state.  The rules must require that the entity file the copy not later than the 60th day before the date of intended use.
(b)  At the expiration of the 60-day period provided by Subsection (a), an advertisement filed in accordance with that subsection is considered acceptable, unless before the end of that 60-day period the department notifies the entity of the advertisement's nonacceptance.
(c)  An entity may not use an advertisement for Medicare supplement benefit plans that does not comply with state law, including department rules and Section 541.084.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 475 (H.B. 2251), Sec. 3, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter E. Agents › Section 1652.201. Information Provided to Agents

Sec. 1652.201.  INFORMATION PROVIDED TO AGENTS.  (a)  An entity that offers a Medicare supplement benefit plan for sale in this state shall provide to each agent authorized to sell that plan information relating to:
(1)  Medicare;
(2)  the Medicare supplement benefit plans offered by that entity;  and
(3)  the agent's ethical obligations to clients.
(b)  The commissioner by rule may prescribe the information that must be provided under this section.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter E. Agents › Section 1652.202. Permitted Compensation Arrangements

Sec. 1652.202.  PERMITTED COMPENSATION ARRANGEMENTS.  (a)  The commissioner by rule shall limit the commission or other compensation that may be paid to an agent for the sale of a Medicare supplement benefit plan or certificate, including a replacement plan or certificate.
(b)  The rules must conform to, but may not be more restrictive than, the requirements of federal law necessary for this state to obtain or retain certification as a state with an approved regulatory program.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 4, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter F. Outpatient Prescription Drugs › Section 1652.251. Outpatient Prescription Drug Benefit Plans

Sec. 1652.251.  OUTPATIENT PRESCRIPTION DRUG BENEFIT PLANS.  (a)  An entity described by Section 1652.003 that issues a Medicare supplement benefit plan in this state may offer a group or individual policyholder:
(1)  an outpatient prescription drug benefit plan authorized under 42 U.S.C. Section 1395ss; or
(2)  a new or innovative outpatient prescription drug benefit plan filed with and approved by the commissioner under Section 1652.055.
(b)  The commissioner shall approve or disapprove an outpatient drug benefit plan described by Subsection (a) that is filed for approval under Section 1652.055 not later than the 60th day after the date the entity files the plan with the department. A drug benefit plan that has not been approved or disapproved by the commissioner before the 61st day after the date the plan is filed with the department is considered approved on that day.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.075(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1652 - Medicare Supplement Benefit Plans › Subchapter F. Outpatient Prescription Drugs › Section 1652.252. Prescription Drug Discount Programs

Sec. 1652.252.  PRESCRIPTION DRUG DISCOUNT PROGRAMS.  (a)  In this section, "prescription drug discount program" means any program that entitles a participant to purchase prescription drugs or other medical supplies and services from vendors at a discount under an agreement made with a participating pharmacy.
(b)  An entity described by Section 1652.003 may offer participation in a prescription drug discount program in connection with the solicitation of an application for issuance of a Medicare supplement benefit plan.
(c)  An offer of participation in a prescription drug discount program described by this section is not a violation of Chapter 541 or any other law prohibiting the offer of rebates in the solicitation of insurance policies.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.075(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1653 - High Deductible Health Plan › Section 1653.001. Definition

Sec. 1653.001.  DEFINITION.  In this chapter, "high deductible health plan" has the meaning assigned by Section 223, Internal Revenue Code of 1986.
Added by Acts 2005, 79th Leg., Ch. 151 (H.B. 1602), Sec. 1, eff. May 24, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1653 - High Deductible Health Plan › Section 1653.002. Applicability of Other Law

Sec. 1653.002.  APPLICABILITY OF OTHER LAW.  (a)  Subject to Subsection (b), a high deductible health plan is subject to any law mandating a minimum health insurance benefit or reimbursement.
(b)  Notwithstanding any other law, a provision of this code may not be construed to prevent an insurer, health maintenance organization, or other entity issuing a health insurance policy or certificate of coverage from applying deductible or copayment requirements to benefits, including state-mandated health benefits, in order to qualify the health insurance policy or certificate of coverage as a high deductible health plan.
Added by Acts 2005, 79th Leg., Ch. 151 (H.B. 1602), Sec. 1, eff. May 24, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle I - Specialized Coverages › Chapter 1653 - High Deductible Health Plan › Section 1653.003. Rules

Sec. 1653.003.  RULES.  The commissioner shall adopt rules necessary to implement this chapter.
Added by Acts 2005, 79th Leg., Ch. 151 (H.B. 1602), Sec. 1, eff. May 24, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter A. General Provisions › Section 1660.001. Findings and Purpose

Sec. 1660.001.  FINDINGS AND PURPOSE.  (a)  The legislature finds that patients deserve accurate, instantaneous information about coverage and financial responsibility to make well-informed decisions about their treatment and spending.
(b)  The legislature finds that the ability of health benefit plan issuers and administrators to exchange eligibility and benefit information with physicians, health care providers, hospitals, and patients will ensure a more efficient and effective health care delivery system.
(c)  The legislature finds that electronic access to eligibility information will reduce the amount of time and resources spent on administrative functions, prevent abuse and fraud, streamline and simplify processing of insurance claims, and increase transparency in premium cost and health care cost.
(d)  The legislature finds that patients often request information about their health care coverage from their health care providers and that health care providers therefore need access to real-time information about their patients' eligibility to receive health care under the health benefit plan, coverage of health care under the health benefit plan, and the benefits associated with the health benefit plan.
(e)  The legislature finds that adoption of technology by insurers, health maintenance organizations, and health care providers to facilitate use of electronic data exchange standards currently available will make coverage and health care electronic transactions more predictable, reliable, and consistent.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter A. General Provisions › Section 1660.002. Definitions

Sec. 1660.002.  DEFINITIONS.  In this chapter:
(1)  "Administrator" has the meaning assigned by Section 4151.001.
(2)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1147, Sec. 2.008(7), eff. September 1, 2011.
(3)  "Enrollee" means an individual who is insured by or enrolled in a health benefit plan.
(4)  "Health benefit plan" means an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an evidence of coverage that provides health insurance or health care benefits.
(5)  "Transaction standards" means the Health Insurance Portability and Accountability Act of 1996 (Pub. L. No. 104-191) transaction standards of the Centers for Medicare and Medicaid Services under 45 C.F.R. Part 162.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.008(7), eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter A. General Provisions › Section 1660.003. Applicability

Sec. 1660.003.  APPLICABILITY.  (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 insurance 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.
Text of subsection effective until April 01, 2025
(b)  This chapter does not apply to:
(1)  a Medicaid managed care program operated under Chapter 533, Government Code;
(2)  a Medicaid program operated under Chapter 32, Human Resources Code;
(3)  the state child health plan or any similar plan operated under Chapter 62 or 63, Health and Safety Code; or
(4)  a health benefit plan offered by an insurer or health maintenance organization that provides coverage only for dental services.
Text of subsection effective on April 01, 2025
(b)  This chapter does not apply to:
(1)  a Medicaid managed care program operated under Chapter 540 or 540A, Government Code, as applicable;
(2)  a Medicaid program operated under Chapter 32, Human Resources Code;
(3)  the state child health plan or any similar plan operated under Chapter 62 or 63, Health and Safety Code; or
(4)  a health benefit plan offered by an insurer or health maintenance organization that provides coverage only for dental services.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.137, eff. April 1, 2025.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter A. General Provisions › Section 1660.004. General Rulemaking

Sec. 1660.004.  GENERAL RULEMAKING.  The commissioner may adopt rules as necessary to implement this chapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.003, eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter C. Identification Card Pilot Program › Section 1660.101. Pilot Program

Sec. 1660.101.  PILOT PROGRAM.  (a)  The commissioner shall designate a county or counties for initial participation in an identification card pilot program to begin not later than May 1, 2008.
(b)  The commissioner shall require the issuer of a health benefit plan that is offered in the county or counties selected for initial participation in the identification card pilot program to issue identification cards that comply with commissioner rules to each enrollee of the plan.
(c)  Repealed by Acts 2011, 82nd Leg., R.S., Ch. 1147, Sec. 2.008(9), eff. September 1, 2011.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.008(9), eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter C. Identification Card Pilot Program › Section 1660.102. Pilot Program Rules

Sec. 1660.102.  PILOT PROGRAM RULES.  (a)  The commissioner shall adopt rules as necessary to implement the identification card pilot program, including the coordination of a testing phase and incorporation of changes identified in the testing phase.
(b)  The commissioner may consider recommendations or any other information provided in response to a department-issued request for information relating to electronic data exchange, including identification card programs, before adopting rules regarding:
(1)  information to be included on the identification cards;
(2)  technology to be used to implement the identification card pilot program; and
(3)  confidentiality and accuracy of the information required to be included on the identification cards.
(c)  The commissioner shall consider the requirements of any federal program requiring health benefit plan issuers and administrators to provide point-of-service access to physicians and other health care providers regarding eligibility information before adopting rules to implement this section.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 2.004, eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter C. Identification Card Pilot Program › Section 1660.103. Requests for Information

Sec. 1660.103.  REQUESTS FOR INFORMATION.  The commissioner may issue requests for information as needed to implement the identification card pilot program under this subchapter.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1660 - Electronic Data Exchange › Subchapter C. Identification Card Pilot Program › Section 1660.104. Health Benefit Plan Issuer Compliance

Sec. 1660.104.  HEALTH BENEFIT PLAN ISSUER COMPLIANCE.  (a)  Each issuer of a health benefit plan that offers a health benefit plan in a county or counties designated by the commissioner under Section 1660.101 for initial participation in the identification card pilot program shall comply with this subchapter and rules adopted under this subchapter.
(b)  To ensure timely compliance with the requirements of this subchapter, the commissioner may require the issuer of a health benefit plan to submit its procedures for implementation of the requirements to the department in the form prescribed by the commissioner.
Added by Acts 2007, 80th Leg., R.S., Ch. 209 (H.B. 522), Sec. 1, eff. May 25, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.001. Definitions

Sec. 1661.001.  DEFINITIONS.  In this chapter:
(1)  "Health benefit plan" means a 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 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 Lloyd's plan operating under Chapter 941;
(F)  an exchange operating under Chapter 942;
(G)  a health maintenance organization operating under Chapter 843;
(H)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;
(I)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or
(J)  an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis.
(2)  "Health benefit plan issuer" means an entity authorized to issue a health benefit plan in this state.
(3)  "Health care provider" means:
(A)  an individual who is licensed, certified, or otherwise authorized to provide health care services; or
(B)  a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.
(4)  "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle J - Health Information Technology and Availability › Chapter 1661 - Information Technology › Section 1661.002. Use of Certain Information Technology Required

Sec. 1661.002.  USE OF CERTAIN INFORMATION TECHNOLOGY REQUIRED.  (a)  A health benefit plan issuer shall use information technology that provides a participating provider with real-time information at the point of care concerning:
(1)  the enrollee's:
(A)  copayment and coinsurance;
(B)  applicable deductibles; and
(C)  covered benefits and services; and
(2)  the enrollee's estimated total financial responsibility for the care.
(b)  A health benefit plan issuer shall use information technology that provides an enrollee with information concerning the enrollee's:
(1)  copayment and coinsurance;
(2)  applicable deductibles;
(3)  covered benefits and services; and
(4)  estimated financial responsibility for the health care provided to the enrollee.
(c)  Nothing in this section may be interpreted as a guarantee of payment for health care services.
(d)  A health benefit plan issuer's Internet website may be used to meet the information technology requirements of this chapter.
Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342), Sec. 1, eff. May 30, 2009.