reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter H. Marketing of Small Employer Health Benefit Plans › Section 1501.358. Applicability to Third-Party Administrator

Sec. 1501.358.  APPLICABILITY TO THIRD-PARTY ADMINISTRATOR.  If a small employer health benefit plan issuer enters into an agreement with a third-party administrator to provide administrative, marketing, or other services related to offering small employer health benefit plans to small employers in this state, the third-party administrator is subject to Sections 1501.111, 1501.351-1501.353, and 1501.355-1501.357.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.601. Participation Criteria

Sec. 1501.601.  PARTICIPATION CRITERIA.  (a)  In this subchapter, "participation criteria" means any criteria or rules established by a large employer to determine the employees who are eligible for enrollment or continued enrollment under the terms of a health benefit plan.
(b)  The participation criteria may not be based on health status related factors.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.602. Coverage Requirements

Sec. 1501.602.  COVERAGE REQUIREMENTS.  (a)  A large employer health benefit plan issuer:
(1)  may refuse to provide coverage to a large employer in accordance with the issuer's underwriting standards and criteria;
(2)  shall accept or reject the entire group of individuals who meet the participation criteria and choose coverage;  and
(3)  may exclude only those employees or dependents who decline coverage.
(b)  On issuance of a health benefit plan to a large employer, a large employer health benefit plan issuer shall provide coverage to the employees who meet the participation criteria without regard to an individual's health status related factors.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.603. Exclusion of Eligible Employee or Dependent Prohibited

Sec. 1501.603.  EXCLUSION OF ELIGIBLE EMPLOYEE OR DEPENDENT PROHIBITED.  A large employer health benefit plan issuer may not exclude an employee who meets the participation criteria or an eligible dependent, including a late enrollee, who would otherwise be covered under a large employer group.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.604. Declining Coverage

Sec. 1501.604.  DECLINING COVERAGE.  (a)  A large employer health benefit plan issuer shall obtain a written waiver from each employee who meets the participation criteria and declines coverage under a health benefit plan offered to a large employer.  The waiver must ensure that the employee was not induced or pressured to decline coverage because of the employee's health status related factors.
(b)  A large employer health benefit plan issuer may not provide coverage to a large employer or the employer's employees if the issuer or an agent for the issuer knows that the employer has induced or pressured an employee who meets the participation criteria or a dependent of the employee to decline coverage because of the individual's health status related factors.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.605. Minimum Contribution or Participation Requirements

Sec. 1501.605.  MINIMUM CONTRIBUTION OR PARTICIPATION REQUIREMENTS.  (a)  A large employer health benefit plan issuer may require a large employer to meet a minimum contribution or participation requirement as a condition of issuance or renewal in accordance with the issuer's usual and customary practices for all the issuer's employer health benefit plans in this state.
(b)  A participation requirement may determine the percentage of eligible employees who meet the participation criteria and who must be enrolled in the health benefit plan.
(c)  A large employer health benefit plan issuer may apply a participation requirement to a large employer's eligible employees, but may not apply the requirement to eligible dependents of those employees.
(d)  A participation requirement must be stated in the health benefit plan contract and must be applied uniformly to each large employer offered or issued coverage by a large employer health benefit plan issuer in this state.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.606. Employee Enrollment; Waiting Period

Sec. 1501.606.  EMPLOYEE ENROLLMENT;  WAITING PERIOD.  (a)  The initial enrollment period for employees meeting the participation criteria under a large employer health benefit plan must be at least 31 days, with a 31-day annual open enrollment period.
(b)  A large employer may establish a waiting period.  The employer shall determine the duration of the waiting period.
(c)  A new employee who meets the participation criteria may not be denied coverage if the application for coverage is received by the large employer not later than the 31st day after the later of:
(1)  the date employment begins;  or
(2)  the date the waiting period established under Subsection (b) expires.
(d)  If dependent coverage is offered to the enrollees under a large employer health benefit plan:
(1)  the initial enrollment period for the dependents must be at least 31 days, with a 31-day annual open enrollment period;  and
(2)  a dependent of a new employee who meets the participation criteria may not be denied coverage if the application for coverage is received by the large employer not later than the 31st day after the latest of:
(A)  the date on which the employment begins;
(B)  the date the waiting period established under Subsection (b) expires;  or
(C)  the date the dependent becomes eligible for enrollment.
(e)  A late enrollee may be excluded from coverage until the next annual open enrollment period and may be subject to a one-year preexisting condition provision as described by Section 1501.102.  The period during which a preexisting condition provision applies may not exceed 18 months from the date of the initial application.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.607. Coverage for Newborn Children

Sec. 1501.607.  COVERAGE FOR NEWBORN CHILDREN.  (a)  A large employer health benefit plan may not limit or exclude initial coverage of a newborn child of a covered employee.
(b)  Coverage of a newborn child of a covered employee under this section ends on the 32nd day after the date of the child's birth unless:
(1)  children are eligible for coverage under the large employer health benefit plan;  and
(2)  not later than the 31st day after the date of birth, the large employer health benefit plan issuer receives:
(A)  notice of the birth;  and
(B)  any required additional premium.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.608. Coverage for Adopted Children

Sec. 1501.608.  COVERAGE FOR ADOPTED CHILDREN.  (a)  This section applies only if children are eligible for coverage under a large employer health benefit plan.
(b)  A large employer health benefit plan may not limit or exclude initial coverage of an adopted child of an insured.  A child is considered to be the adopted child of an insured if the insured is a party to a suit in which the insured seeks to adopt the child.
(c)  An adopted child of an insured may be enrolled, at the insured's option, not later than the 31st day after:
(1)  the date the insured becomes a party to a suit in which the insured seeks to adopt the child;  or
(2)  the date the adoption becomes final.
(d)  Coverage of an adopted child of an insured under this section ends unless the large employer health benefit plan issuer receives notice of the adoption and any required additional premium not later than the 31st day after:
(1)  the date the insured becomes a party to a suit in which the insured seeks to adopt the child;  or
(2)  the date the adoption becomes final.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.609. Coverage for Unmarried Children

Sec. 1501.609.  COVERAGE FOR UNMARRIED CHILDREN.  (a)  This section applies only if children are eligible for coverage under a large employer health benefit plan.
(b)  Any limiting age applicable under a large employer health benefit plan to an unmarried child of an enrollee is 25 years of age.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.610. Premium Rates; Adjustments

Sec. 1501.610.  PREMIUM RATES;  ADJUSTMENTS.  (a)  A large employer health benefit plan issuer may charge premiums in accordance with this section to the group of employees or dependents who meet the participation criteria and do not decline coverage.
(b)  A large employer health benefit plan issuer may not charge an adjustment to premium rates for individual employees or dependents for health status related factors or duration of coverage.  Any adjustment must be applied uniformly to the rates charged for all employees and dependents of employees of a large employer.
(c)  Subsection (b) does not restrict the amount that a large employer may be charged for coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.611. Marketing Requirements

Sec. 1501.611.  MARKETING REQUIREMENTS.  On request, each large employer purchasing a health benefit plan shall be given a summary of all plans for which the employer is eligible.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.612. Encouraging Exclusion of Employee Prohibited

Sec. 1501.612.  ENCOURAGING EXCLUSION OF EMPLOYEE PROHIBITED.  A large employer health benefit plan issuer or agent may not encourage a large employer to exclude an employee who meets the participation criteria from health coverage provided in connection with the employee's employment.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.613. Agents

Sec. 1501.613.  AGENTS.  A large employer health benefit plan issuer may not terminate, fail to renew, or limit its contract or agreement of representation with an agent because of health status related factors of a large employer group placed by the agent with the issuer.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.615. Additional Reporting Requirements

Sec. 1501.615.  ADDITIONAL REPORTING REQUIREMENTS.  The department may require periodic reports by large employer health benefit plan issuers and agents regarding the large employer health benefit plans issued by those issuers.  The reporting requirements must:
(1)  require information regarding the number of plans in various categories that are marketed or issued to large employers;  and
(2)  comply with federal law, including regulations.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1501 - Health Insurance Portability and Availability Act › Subchapter M. Large Employer Health Benefit Plans › Section 1501.616. Applicability to Third-Party Administrator

Sec. 1501.616.  APPLICABILITY TO THIRD-PARTY ADMINISTRATOR.  If a large employer health benefit plan issuer enters into an agreement with a third-party administrator to provide administrative, marketing, or other services related to offering large employer health benefit plans to large employers in this state, the third-party administrator is subject to this subchapter and Subchapter C.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1502 - Health Benefit Plans for Children › Subchapter A. General Provisions › Section 1502.001. Applicability of Chapter

Sec. 1502.001.  APPLICABILITY OF CHAPTER.  This chapter applies only to the issuer of 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:
(A)  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:
(i)  an insurance company;
(ii)  a group hospital service corporation operating under Chapter 842;
(iii)  a fraternal benefit society operating under Chapter 885;
(iv)  a stipulated premium company operating under Chapter 884;  or
(v)  a health maintenance organization operating under Chapter 843;  and
(B)  to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:
(i)  a multiple employer welfare arrangement as defined by Section 3 of that Act or another analogous benefit arrangement;  or
(ii)  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;  or
(2)  is offered by 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.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1502 - Health Benefit Plans for Children › Subchapter A. General Provisions › Section 1502.0011. Exception

Sec. 1502.0011.  EXCEPTION.  This chapter does not apply to a health benefit plan provided under the state Medicaid program or the state child health plan.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.061(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1502 - Health Benefit Plans for Children › Subchapter A. General Provisions › Section 1502.002. Rules

Sec. 1502.002.  RULES.  (a) The commissioner may adopt rules to implement this chapter, including rules necessary to:
(1)  increase the availability of coverage to children younger than 19 years of age;
(2)  establish an open enrollment period; and
(3)  establish qualifying events as exceptions to the open enrollment period, including loss of coverage when a child becomes ineligible for coverage under the state child health plan.
(b)  The commissioner may adopt rules on an emergency basis using the procedures established under Section 2001.034, Government Code.
(c)  Notwithstanding Subsection (b), the commissioner is not required to make a finding under Section 2001.034(a), Government Code, before adopting rules on an emergency basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2011, 82nd Leg., R.S., Ch. 1147 (H.B. 1951), Sec. 9.001, eff. September 1, 2011.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1502 - Health Benefit Plans for Children › Subchapter B. Children's Health Benefit Plan › Section 1502.051. Children's Health Benefit Plan

Sec. 1502.051.  CHILDREN'S HEALTH BENEFIT PLAN.  A health benefit plan issuer may offer a children's health benefit plan that provides coverage only to children younger than 18 years of age.  The issuer may offer the plan only if the commissioner approves the plan's structure and the benefits offered under the plan.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1502 - Health Benefit Plans for Children › Subchapter B. Children's Health Benefit Plan › Section 1502.052. Mandated Benefit Provisions Inapplicable

Sec. 1502.052.  MANDATED BENEFIT PROVISIONS INAPPLICABLE.  A children's health benefit plan is not subject to any law that requires coverage or the offer of coverage of a health care service or benefit.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1502 - Health Benefit Plans for Children › Subchapter B. Children's Health Benefit Plan › Section 1502.053. Exemption From Certain Taxes

Sec. 1502.053.  EXEMPTION FROM CERTAIN TAXES.  (a)  The issuer of a children's health benefit plan approved under Section 1502.051 is not subject to the premium tax or the tax on revenues imposed under Chapter 222 with respect to money received for coverage provided under that plan.
(b)  The issuer of a children's health benefit plan approved under Section 1502.051 is not subject to the retaliatory tax imposed under Chapter 281 with respect to money received for coverage provided under that plan.
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. 11.062(a), eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 932 (H.B. 3315), Sec. 19, eff. June 15, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1503 - Coverage of Certain Students › Section 1503.001. Applicability of Chapter

Sec. 1503.001.  APPLICABILITY OF CHAPTER.  This chapter 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:
(A)  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:
(i)  an insurance company;
(ii)  a group hospital service corporation operating under Chapter 842;
(iii)  a fraternal benefit society operating under Chapter 885;
(iv)  a stipulated premium company operating under Chapter 884;  or
(v)  a health maintenance organization operating under Chapter 843;  and
(B)  to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:
(i)  a multiple employer welfare arrangement as defined by Section 3 of that Act;  or
(ii)  an analogous benefit arrangement;  or
(2)  is offered by:
(A)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;  or
(B)  another entity that:
(i)  is not authorized under this code or another insurance law of this state;  and
(ii)  contracts directly for health care services on a risk-sharing basis, including a capitation basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1503 - Coverage of Certain Students › Section 1503.002. Exception

Sec. 1503.002.  EXCEPTION.  This chapter does not apply to:
(1)  a plan that provides coverage:
(A)  only for a specified disease;
(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;  or
(D)  as a supplement to a liability insurance policy;
(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 1503.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1503 - Coverage of Certain Students › Section 1503.003. Coverage of Certain Students

Sec. 1503.003.  COVERAGE OF CERTAIN STUDENTS.  (a)  A health benefit plan may not condition coverage for a child younger than 25 years of age on the child's being enrolled at an educational institution.
(b)  A health benefit plan that requires as a condition of coverage for a child 25 years of age or older that the child be a full-time student at an educational institution must provide the coverage:
(1)  for the entire academic term during which the child begins as a full-time student and remains enrolled, regardless of whether the number of hours of instruction for which the child is enrolled is reduced to a level that changes the child's academic status to less than that of a full-time student; and
(2)  continuously until the 10th day of instruction of the subsequent academic term, on which date the health benefit plan may terminate coverage for the child if the child does not return to full-time student status before that date.
(c)  For purposes of this section, determination of the full-time student status of a child is made in the manner provided by the educational institution at which the child is enrolled.
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. 11.063(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter A. General Provisions › Section 1504.001. Definitions

Sec. 1504.001.  DEFINITIONS.  In this chapter:
(1)  "Child" has the meaning assigned by Section 101.003, Family Code.
(2)  "Child support agency" has the meaning assigned by Section 101.004, Family Code.
(3)  "Custodial parent" means an individual who:
(A)  is a managing conservator of a child or a possessory conservator of a child who is a parent of the child;  or
(B)  is a guardian of the person or other custodian of a child and is designated as guardian or custodian by a court or administrative agency of this or another state.
(4)  "Benefit plan issuer" means:
(A)  an insurance company, group hospital service corporation, or health maintenance organization that delivers or issues for delivery an individual, group, blanket, or franchise insurance policy or agreement, a group hospital service contract, or an evidence of coverage that provides benefits for medical or surgical expenses incurred as a result of an accident or sickness, or dental expenses;
(B)  a governmental entity subject to Subchapter D, Chapter 1355, Subchapter C, Chapter 1364, Chapter 1578, Article 3.51-1, 3.51-4, or 3.51-5, or Chapter 177, Local Government Code;
(C)  the issuer of a multiple employer welfare arrangement as defined by Section 846.001; or
(D)  the issuer of a group health plan as defined by Section 607, Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1167).
(5)  "Medical assistance" means medical assistance under the state Medicaid program.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2G.016, eff. April 1, 2009.
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 60, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter A. General Provisions › Section 1504.002. Rules

Sec. 1504.002.  RULES.  (a)  The commissioner shall adopt reasonable rules as necessary to implement this chapter and 42 U.S.C. Section 1396a(a)(60), including rules that define acts that constitute unfair or deceptive practices under Subchapter I, Chapter 541.
(b)  The commissioner shall adopt rules that define "comparable health or dental coverage" in a manner that:
(1)  is consistent with federal law; and
(2)  complies with the requirements necessary to maintain federal Medicaid funding.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 61, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter A. General Provisions › Section 1504.003. Violation of Chapter: Relief Available to Injured Person

Sec. 1504.003.  VIOLATION OF CHAPTER:  RELIEF AVAILABLE TO INJURED PERSON.  A benefit plan issuer that violates this chapter is subject to the same penalties, and an injured person has the same rights and remedies, as those provided by Subchapter D, Chapter 541.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 62, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter B. Duties of Benefit Plan Issuer › Section 1504.051. Enrollment of Certain Children Required

Sec. 1504.051.  ENROLLMENT OF CERTAIN CHILDREN REQUIRED.  (a)  A benefit plan issuer shall permit a parent to enroll a child in dependent health or dental coverage offered through the issuer regardless of any enrollment period restriction if the parent is:
(1)  eligible for dependent health or dental coverage; and
(2)  required by a court order or administrative order to provide health or dental insurance coverage for the child.
(b)  A benefit plan issuer shall enroll a child of a parent described by Subsection (a) in dependent health or dental coverage offered through the issuer if:
(1)  the parent does not apply to obtain health or dental coverage for the child through the issuer; and
(2)  the child, a custodial parent of the child, or a child support agency having a duty to collect or enforce support for the child applies for the coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 64, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter B. Duties of Benefit Plan Issuer › Section 1504.052. Child Residing Outside Service Area; Comparable Health or Dental Coverage Required

Sec. 1504.052.  CHILD RESIDING OUTSIDE SERVICE AREA; COMPARABLE HEALTH OR DENTAL COVERAGE REQUIRED.  (a)  A benefit plan issuer may not deny enrollment of a child under the health or dental coverage of the child's parent on the ground that the child does not reside in the issuer's service area.
(b)  A benefit plan issuer may not enforce an otherwise applicable provision of the health or dental coverage that would deny, limit, or reduce payment of a claim for a covered child who resides outside the issuer's service area but inside the United States.
(c)  For a covered child who resides outside the benefit plan issuer's service area and whose coverage under a policy or plan is required by a medical support order or dental support order, the issuer shall provide coverage that is comparable health or dental coverage to that provided to other dependents under the policy or plan.
(d)  Comparable health or dental coverage may include coverage in which a benefit plan issuer uses different procedures for service delivery and health care provider reimbursement.  Comparable health or dental coverage may not include coverage:
(1)  that is limited to emergency services only; or
(2)  for which the issuer charges a higher premium.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 65, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter B. Duties of Benefit Plan Issuer › Section 1504.053. Cancellation or Nonrenewal of Coverage for Certain Children

Sec. 1504.053.  CANCELLATION OR NONRENEWAL OF COVERAGE FOR CERTAIN CHILDREN.  (a)  A benefit plan issuer may not cancel or refuse to renew health or dental coverage provided to a child who is enrolled or entitled to enrollment under this chapter unless satisfactory written evidence is filed with the issuer showing that:
(1)  the court or administrative order that required the coverage is not in effect; or
(2)  the child:
(A)  is enrolled in comparable health or dental coverage; or
(B)  will be enrolled in comparable health or dental coverage that takes effect not later than the effective date of the cancellation or nonrenewal.
(b)  For purposes of this section, a child is not enrolled or entitled to enrollment under this chapter if the child's eligibility for health or dental coverage ends because the parent ceases to be eligible for dependent health or dental coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 66, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter B. Duties of Benefit Plan Issuer › Section 1504.054. Continuation or Conversion of Coverage

Sec. 1504.054.  CONTINUATION OR CONVERSION OF COVERAGE.  (a)  If a child's eligibility for dependent health or dental coverage ends because the parent ceases to be eligible for the coverage and the coverage provides for the continuation or conversion of the coverage for the child, the benefit plan issuer shall notify the custodial parent and the child support agency of the costs and other requirements for continuing or converting the coverage.
(b)  The benefit plan issuer shall, on application of a parent of the child, a child support agency, or the child, enroll or continue enrollment of a child whose eligibility for coverage ended under Subsection (a).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 67, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter B. Duties of Benefit Plan Issuer › Section 1504.055. Procedure for Claims

Sec. 1504.055.  PROCEDURE FOR CLAIMS.  (a)  A benefit plan issuer that provides health or dental coverage to a child through a covered parent of the child shall:
(1)  provide to each custodial parent of the child or to an adult child documents and other information necessary for the child to obtain benefits under the coverage, including:
(A)  the name of the issuer;
(B)  the number of the policy or evidence of coverage;
(C)  a copy of the policy or evidence of coverage and schedule of benefits;
(D)  a health or dental coverage membership card;
(E)  claim forms; and
(F)  any other document or information necessary to submit a claim in accordance with the issuer's policies and procedures;
(2)  permit a custodial parent, health care provider, state agency that has been assigned medical or dental support rights, or adult child to submit claims for covered services without the approval of the covered parent; and
(3)  make payments on covered claims submitted in accordance with this subsection directly to a custodial parent, health care or dental care provider, adult child, or state agency making a claim.
(b)  A benefit plan issuer shall provide to a state agency that provides medical assistance, including medical assistance for dental services, to the child or shall provide to a child support agency that enforces medical or dental support on behalf of a child the information necessary to obtain reimbursement of medical or dental services provided to or paid on behalf of the child.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 68, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter C. Prohibited Conduct › Section 1504.101. Denial of Enrollment on Certain Grounds Prohibited

Sec. 1504.101.  DENIAL OF ENROLLMENT ON CERTAIN GROUNDS PROHIBITED.  A benefit plan issuer may not deny enrollment of a child under the health or dental coverage of the child's parent on the ground that the child:
(1)  has a preexisting condition;
(2)  was born out of wedlock;
(3)  is not claimed as a dependent on the parent's federal income tax return;
(4)  does not reside with the parent; or
(5)  receives or has applied for medical assistance.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 69, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1504 - Medical and Dental Child Support › Subchapter C. Prohibited Conduct › Section 1504.102. Assignment of Medical or Dental Support Rights: Different Requirements Prohibited

Sec. 1504.102.  ASSIGNMENT OF MEDICAL OR DENTAL SUPPORT RIGHTS:  DIFFERENT REQUIREMENTS PROHIBITED.  A benefit plan issuer may not require a state agency that has been assigned the rights of an individual who is eligible for medical assistance and is covered for health or dental benefits from the issuer to comply with a requirement that is different from a requirement imposed on an agent or assignee of any other covered individual.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2015, 84th Leg., R.S., Ch. 1150 (S.B. 550), Sec. 70, eff. September 1, 2018.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.001. Definition

Sec. 1505.001.  DEFINITION.  In this chapter, "health insurer" means an insurance company authorized to provide a hospital, surgical, and medical expense insurance plan in this state, including:
(1)  a stock insurance company;
(2)  a reciprocal or interinsurance exchange;
(3)  a Lloyd's plan;
(4)  a fraternal benefit society;
(5)  a stipulated premium company;  and
(6)  a mutual insurance company, including a statewide mutual assessment company or a local mutual aid association.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.002. Plans for Certain Persons 65 Years of Age or Older

Sec. 1505.002.  PLANS FOR CERTAIN PERSONS 65 YEARS OF AGE OR OLDER.  (a)  Two or more health insurers may provide a hospital, surgical, and medical expense insurance plan under a group insurance policy that covers residents of this state who are at least 65 years of age and the spouses of those residents.
(b)  The participating health insurers may enter into agreements regarding matters within the scope of this chapter, including:
(1)  premium rates;
(2)  policy provisions;  and
(3)  sales, administrative, technical, and accounting procedures.
(c)  Each participating health insurer is subject to regulation under the laws of this state and is severally liable on a group insurance policy issued under this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.003. Application and Other Evidence of Insurance Forms

Sec. 1505.003.  APPLICATION AND OTHER EVIDENCE OF INSURANCE FORMS.  An application, policy, certificate, or other evidence of insurance form for an insurance plan under this chapter is subject to Chapter 1701.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.004. Execution of Policy

Sec. 1505.004.  EXECUTION OF POLICY.  An authorized person may execute an insurance policy subject to this chapter on behalf of the participating health insurers.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.005. Use of Unincorporated Entity

Sec. 1505.005.  USE OF UNINCORPORATED ENTITY.  (a)  The participating health insurers may issue the group insurance policy in their own names or in the name of an unincorporated association, trust, or other organization formed for the sole purposes of this chapter and evidenced by a written contract executed by the insurers.  An unincorporated association, trust, or other organization formed under this subsection may sue and be sued in the name of the association, trust, or organization.
(b)  A person licensed as a general life, accident, and health agent under Chapter 4054, as a general property and casualty agent under Chapter 4051 authorized to write health and accident insurance under Section 4051.053, or as a personal lines property and casualty agent authorized to write health and accident insurance under Section 4051.402, may act in the licensed capacity in connection with an insurance policy or a certificate of insurance issued by an unincorporated association, trust, or other organization formed under Subsection (a).  The agent is not required to notify the department that the person has been appointed to act for that purpose.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 548 (S.B. 1263), Sec. 2.12, eff. September 1, 2007.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.006. Required Filings; Department Approval

Sec. 1505.006.  REQUIRED FILINGS;  DEPARTMENT APPROVAL.  (a)  The participating health insurers shall provide for the filing with the department on behalf of the insurers of:
(1)  a copy of any contract of association or organization or trust agreement entered into by the insurers under this chapter;
(2)  the schedule of premium rates to be charged for the insurance coverage;  and
(3)  the plan for operating and marketing the insurance.
(b)  Except as provided by Subsection (c), a contract, schedule, or plan described by Subsection (a) may not be effective until approved by the commissioner.
(c)  A contract, schedule, or plan described by Subsection (a) that is not approved or disapproved in a written order of the commissioner on or before the 30th day after the date on which the document is filed with the department is considered approved on the 31st day after the date of filing.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.007. Effect of Commissioner Disapproval

Sec. 1505.007.  EFFECT OF COMMISSIONER DISAPPROVAL.  If, after notice and public hearing, the commissioner determines under reasonable assumptions that a premium rate charged for the insurance coverage offered under this chapter or the plan for operating and marketing that insurance is excessive, inadequate, or contrary to the public interest or that any activity or practice performed in connection with the insurance is unfair, unreasonable, or contrary to the public interest, the commissioner shall:
(1)  enter an order containing the commissioner's determination and disapproving the premium rate or plan or the activity or practice;  and
(2)  require the discontinuance of the premium rate, plan, activity, or practice within a period that is not less than 30 days after the date of the commissioner's order containing the determination.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.008. Exemption From Premium Taxes

Sec. 1505.008.  EXEMPTION FROM PREMIUM TAXES.  Each premium received for group insurance coverage authorized by this chapter is exempt from any premium tax imposed by any other law of this state.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1505 - Group Health Insurance Plans for Persons 65 Years of Age or Older › Section 1505.009. Exemption From Certain Antitrust Requirements

Sec. 1505.009.  EXEMPTION FROM CERTAIN ANTITRUST REQUIREMENTS.  An association, trust, or other organization formed and operated in accordance with this chapter or an insurance business conducted in accordance with this chapter is not considered a combination in restraint of trade, an illegal monopoly, or an attempt to lessen competition or fix prices arbitrarily and does not otherwise violate the antitrust laws of this state.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1507 - Consumer Choice of Benefits Plans › Subchapter A. Consumer Choice of Benefits Health Insurance Plans › Section 1507.001. Purpose

Sec. 1507.001.  PURPOSE.  The legislature recognizes the need for individuals, employers, and other purchasers of coverage in this state to have the opportunity to choose health insurance plans that are more affordable and flexible than existing market policies offering accident and sickness insurance coverage.  The legislature, therefore, seeks to increase the availability of health insurance coverage by allowing insurers authorized to engage in the business of insurance in this state to issue accident and sickness policies that, in whole or in part, do not offer or provide state-mandated health benefits.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle G - Health Coverage Availability › Chapter 1507 - Consumer Choice of Benefits Plans › Subchapter A. Consumer Choice of Benefits Health Insurance Plans › Section 1507.002. Definitions

Sec. 1507.002.  DEFINITIONS.  In this subchapter:
(1)  "Health carrier" means any entity authorized under this code or another insurance law of this state that provides health insurance or health benefits in this state.  The term includes an insurance company, a group hospital service corporation under Chapter 842, and a stipulated premium company under Chapter 884.
(2)  "Standard health benefit plan" means an accident or sickness insurance policy that, in whole or in part, does not offer or provide state-mandated health benefits, but that provides creditable coverage as defined by Section 1205.004(a) or 1501.102(a).
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.