reglab/statecodes huggingface dataset:
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy › Section 1251.259. Termination of Converted Policy

Sec. 1251.259.  TERMINATION OF CONVERTED POLICY.  Conversion coverage under this subchapter for an insured may not terminate until the earlier of:
(1)  the date failure to make timely payments would terminate coverage;  or
(2)  the date of an event specified by Section 1251.255(a)(4), (5), (6), or (7) for termination of continued group coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter F. Continuation or Conversion Privilege on Termination of Coverage Under Group Policy › Section 1251.260. Notice of Continuation and Conversion Privileges

Sec. 1251.260.  NOTICE OF CONTINUATION AND CONVERSION PRIVILEGES.  (a)  An employer that provides to its employees group accident and health insurance coverage that includes a group continuation or conversion privilege on termination of coverage shall give written notice of the continuation or conversion privileges under the policy to each employee or dependent insured under the group and affected by the termination.
(b)  The commissioner by rule shall establish minimum standards for the notice required by this section.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.301. Continuation of Group Coverage

Sec. 1251.301.  CONTINUATION OF GROUP COVERAGE.  A group policy or contract delivered, issued for delivery, renewed, amended, or extended in this state, including a group contract issued by a group hospital service corporation, that provides insurance for hospital, surgical, or medical expenses incurred as a result of accident or sickness must include an option for each individual covered by the policy or contract because of a family or dependent relationship to an individual who is a member of the group for which the policy or contract is provided to continue coverage with the group if the individual's eligibility for coverage under the policy or contract ends because of:
(1)  the severance of the family relationship;  or
(2)  the retirement or death of the group member.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.302. Eligibility for Continued Coverage

Sec. 1251.302.  ELIGIBILITY FOR CONTINUED COVERAGE.  A family member or dependent of an insured is eligible for continued coverage under this subchapter if the family member or dependent:
(1)  has been a member of the group for a period of at least one year;  or
(2)  is an infant under one year 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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.303. Physical Examination Not Required

Sec. 1251.303.  PHYSICAL EXAMINATION NOT REQUIRED.  An individual who exercises the option to continue group coverage under this subchapter may not be required to take and pass a physical examination as a condition to continuing 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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.304. Scope of Coverage

Sec. 1251.304.  SCOPE OF COVERAGE.  (a)  An individual covered under group continuation coverage under this subchapter is entitled to coverage that is identical in scope to the coverage provided under the group health insurance policy or contract.  An exclusion that was not included in the health insurance policy or contract may not be included in the group continuation coverage.
(b)  If the group policyholder or contract holder replaces the health insurance policy or contract within the period prescribed by Section 1251.310(3), an individual covered under group continuation coverage may obtain coverage identical in scope to the coverage under the replacement group policy as provided by this subchapter.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.305. Amount of Premium

Sec. 1251.305.  AMOUNT OF PREMIUM.  Except as provided by Section 1551.064, the premium for continuation of a spouse or dependent on the group health insurance policy or contract may not be more than the premium charged under the group policy or contract for the individual had the family relationship not been severed.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.306. Payment of Premiums

Sec. 1251.306.  PAYMENT OF PREMIUMS.  (a)  An individual covered under group continuation coverage under this subchapter shall pay premiums for the coverage directly to the group policyholder or contract holder.
(b)  The coverage must provide the individual with the option of paying the premiums in monthly installments.
(c)  The group policyholder or contract holder may require the individual to pay a monthly fee of not more than $5 for administrative costs.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.307. Notice of Continuation Option

Sec. 1251.307.  NOTICE OF CONTINUATION OPTION.  Except as provided by Section 1551.064, at the time a health insurance policy or contract is issued, the group policyholder or contract holder shall give written notice to each group member and each dependent of a group member covered by the policy or contract of the continuation option under this subchapter.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.308. Notice of Severance of Family Relationship; Notice of Desire to Exercise Option

Sec. 1251.308.  NOTICE OF SEVERANCE OF FAMILY RELATIONSHIP;  NOTICE OF DESIRE TO EXERCISE OPTION.  (a)  Except as provided by Section 1551.064, each group health insurance policy or contract must require a group member to give written notice to the group policyholder or contract holder not later than the 15th day after the date of any severance of the family relationship that might activate the continuation option under this subchapter.  Written notice under this subsection may be given by the group member's dependent.
(b)  On receipt of notice under Subsection (a), the group policyholder or contract holder shall immediately give written notice of the continuation option under this subchapter to each affected dependent of the group member.
(c)  On receipt of notice of the death or retirement of a group member, the group policyholder or contract holder shall immediately give written notice of the continuation option under this subchapter to each dependent of the group member.  The notice must state the amount of the premium to be charged and must be accompanied by any necessary enrollment forms.
(d)  Not later than the 60th day after the date of the severance of the family relationship or the retirement or death of the group member, a dependent must give written notice to the group policyholder or contract holder of the individual's desire to exercise the continuation option under this subchapter.  Coverage under the health insurance policy or contract remains in effect during the period prescribed by this subsection if the policy or contract premiums are paid.
(e)  If a dependent does not give written notice of the individual's desire to exercise the continuation option under this subchapter within the time prescribed by Subsection (d), the option expires.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.309. Continuation of Certain Coverages

Sec. 1251.309.  CONTINUATION OF CERTAIN COVERAGES.  (a)  Any period of previous coverage under the health insurance policy or contract, including a policy or contract executed under Chapter 1551, must be used in full or partial satisfaction of any required probationary or waiting periods provided in the contract for dependent coverage.
(b)  If a health insurance policy or contract provides to a group member continuation rights to cover the period between the time the member retires and the time the member is eligible for coverage by Medicare, those same continuation rights must be made available to the group member's dependents.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter G. Continuation of Group Coverage for Certain Family Members and Dependents › Section 1251.310. Termination of Continued Coverage

Sec. 1251.310.  TERMINATION OF CONTINUED COVERAGE.  The coverage of an individual who exercises the continuation option under this subchapter continues without interruption and may not be canceled or otherwise terminated until:
(1)  the insured fails to make a premium payment within the time required to make the payment;
(2)  the insured becomes eligible for substantially similar coverage under another plan or program, including a group health insurance policy or contract, hospital or medical service subscriber contract, or medical practice or other prepayment plan;  or
(3)  the third anniversary of:
(A)  the severance of the family relationship;  or
(B)  the retirement or death of the group member.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.351. Common Carrier or Motor Vehicle Rental or Leasing Company

Sec. 1251.351.  COMMON CARRIER OR MOTOR VEHICLE RENTAL OR LEASING COMPANY.  (a)  A blanket accident and health insurance policy may be issued to:
(1)  a common carrier or the operator, owner, or lessor of a means of transportation to cover a group of individuals who may become passengers defined by reference to their travel status on the common carrier or means of transportation;  or
(2)  an automobile or truck rental or leasing company to cover a group of individuals who may become renters, lessees, or passengers defined by their travel status on the rented or leased vehicles.
(b)  The common carrier, the operator, owner, or lessor of a means of transportation, or the automobile or truck rental or leasing company is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.352. Employers

Sec. 1251.352.  EMPLOYERS.  (a)  A blanket accident and health insurance policy may be issued to an employer to cover any group of employees, dependents, or guests defined by reference to specified hazards incident to an activity or operation of the employer.
(b)  The employer is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.353. Educational Institutions

Sec. 1251.353.  EDUCATIONAL INSTITUTIONS.  (a)  A blanket accident and health insurance policy may be issued to a college, school, or other institution of learning, to a school district or school jurisdictional unit, or to the head, principal, or governing board of such an educational unit to cover students, teachers, or employees.
(b)  The institution, head, principal, or governing board is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.354. Religious, Charitable, Recreational, Educational, or Civic Organization

Sec. 1251.354.  RELIGIOUS, CHARITABLE, RECREATIONAL, EDUCATIONAL, OR CIVIC ORGANIZATION.  (a)  A blanket accident and health insurance policy may be issued to a religious, charitable, recreational, educational, or civic organization, or a branch of the organization, to cover any group of members or participants defined by reference to specified hazards incident to an activity or operation sponsored or supervised by the organization or branch.
(b)  The organization or branch is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.355. Sports Team or Camp

Sec. 1251.355.  SPORTS TEAM OR CAMP.  (a)  A blanket accident and health insurance policy may be issued to a sports team or camp or the sponsor of a sports team or camp to cover members, campers, employees, officials, or supervisors.
(b)  The sports team, camp, or sponsor is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.356. Governmental or Volunteer Emergency Services Organization

Sec. 1251.356.  GOVERNMENTAL OR VOLUNTEER EMERGENCY SERVICES ORGANIZATION.  (a)  A blanket accident and health insurance policy may be issued to a governmental or volunteer fire department or fire company, first aid or civil defense organization, or similar governmental or volunteer organization to cover a group of members or participants defined by reference to specified hazards incident to an activity or operation sponsored or supervised by the organization.
(b)  The governmental or volunteer organization is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.357. Newspaper or Other Publisher

Sec. 1251.357.  NEWSPAPER OR OTHER PUBLISHER.  (a)  A blanket accident and health insurance policy may be issued to a newspaper or other publisher to cover the publisher's carriers.
(b)  The publisher is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.358. Association

Sec. 1251.358.  ASSOCIATION.  (a)  A blanket accident and health insurance policy may be issued to an association, including a labor union, to cover any group of members or participants defined by reference to specified hazards incident to an activity or operation sponsored or supervised by the association.
(b)  To be eligible to obtain a blanket accident and health insurance policy, an association must:
(1)  have a constitution and bylaws;  and
(2)  have been organized and be maintained in good faith for purposes other than that of obtaining insurance.
(c)  The association is the policyholder under a policy to which this section applies.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter H. Blanket Accident and Health Insurance: Eligible Policyholders › Section 1251.359. Coverage for Other Risks

Sec. 1251.359.  COVERAGE FOR OTHER RISKS.  (a)  A blanket accident and health insurance policy may be issued to cover any risk or class of risks other than a risk described by this subchapter that, as determined by the commissioner, is eligible for blanket accident and health insurance.
(b)  The commissioner may make a determination under Subsection (a) based on an individual risk, a class of risks, or both.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter I. Blanket Accident and Health Insurance: General Provisions › Section 1251.401. Individual Application and Certificate Not Required

Sec. 1251.401.  INDIVIDUAL APPLICATION AND CERTIFICATE NOT REQUIRED.  (a)  An individual application from an insured under a blanket accident and health insurance policy is not required.
(b)  An insurer is not required to provide a certificate to each insured under a blanket accident and health insurance policy.
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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter I. Blanket Accident and Health Insurance: General Provisions › Section 1251.402. Liability of Policyholder Not Affected

Sec. 1251.402.  LIABILITY OF POLICYHOLDER NOT AFFECTED.  Subchapter H and this subchapter do not affect the legal liability of a policyholder for the death of or injury to a member of a 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 B - Group Health Coverage › Chapter 1251 - Group and Blanket Health Insurance › Subchapter J. Regulation of Out-of-State Group Accident and Health Insurance Coverage › Section 1251.451. Applicability of Certain Laws to Out-of-State Group Accident and Health Insurance Coverage

Sec. 1251.451.  APPLICABILITY OF CERTAIN LAWS TO OUT-OF-STATE GROUP ACCIDENT AND HEALTH INSURANCE COVERAGE.  (a)  Chapters 1365 and 1368 and Subchapters A and C, Chapter 1451, apply to:
(1)  a certificate of insurance issued to a resident of this state under a group accident and health insurance policy delivered, issued for delivery, or renewed outside this state;  or
(2)  a certificate issued to a resident of this state under a policy delivered, issued for delivery, or renewed outside this state by a group hospital service corporation.
(b)  Subsection (a) does not apply to a specified disease or limited benefit policy.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter A. General Provisions › Section 1252.001. Definitions

Sec. 1252.001.  DEFINITIONS.  In this chapter:
(1)  "Carrier" means:
(A)  an insurer;  or
(B)  a group hospital service corporation operating under Chapter 842.
(2)  "Health benefit plan" means:
(A)  any accident and health insurance policy;
(B)  a subscriber contract of a group hospital service corporation;  or
(C)  an accident and health benefits package of a multiple employer trust that is not exempt from regulation by this state as an employee welfare benefit plan under the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), as amended.
(3)  "Previous carrier" means a carrier whose health benefit plan coverage has been replaced with health benefit plan coverage provided by a succeeding carrier.
(4)  "Succeeding carrier" means a carrier that replaces the health benefit plan coverage provided by another carrier with its own health benefit plan coverage.
(5)  "Total disability" or "totally disabled" means:
(A)  with respect to an employee or other primary insured covered under a health benefit plan, the complete inability of that individual to perform all of the substantial and material duties and functions of the individual's occupation and any other gainful occupation in which the individual earns substantially the same compensation earned before the disability;  and
(B)  with respect to any other individual covered under a health benefit plan, confinement as a bed patient in a hospital.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter A. General Provisions › Section 1252.002. Applicability of Chapter

Sec. 1252.002.  APPLICABILITY OF CHAPTER.  (a)  This chapter applies only to a health benefit plan that:
(1)  provides coverage on a group or group-type basis to an individual eligible for that coverage because of the individual's status as:
(A)  an employee of an employer;  or
(B)  a member of a labor union or a member of an association;  and
(2)  is delivered or issued for delivery in this state.
(b)  This chapter does not apply to an entity that is not engaged in the business of insurance 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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter A. General Provisions › Section 1252.003. Coverage Issued on Group-Type Basis

Sec. 1252.003.  COVERAGE ISSUED ON GROUP-TYPE BASIS.  (a)  For purposes of this chapter, health benefit plan coverage is provided on a group-type basis if:
(1)  the plan provides coverage under an insurance policy or subscriber contract to a class of employees or a class of members of a labor union or members of an association and the class is determined by conditions relating to their employment or to their membership in the union or association;
(2)  coverage under the plan is not available to the general public and can be obtained and maintained only because of the covered individual's employment status or membership in a labor union or an association;
(3)  premiums or subscription charges for the plan are paid to the carrier on an aggregate or bulk-payment basis;  and
(4)  the plan is sponsored by:
(A)  the employer of the class of employees covered by the plan;  or
(B)  the labor union or an association to which the class of members covered by the plan belongs.
(b)  Health benefit plan coverage is not provided on a group-type basis if it is a salary-budget plan using individual insurance policies or subscriber contracts that do not meet the conditions for group-type coverage specified by Subsection (a).
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter B. Discontinuation of Coverage › Section 1252.101. Notice of Discontinuation of Coverage

Sec. 1252.101.  NOTICE OF DISCONTINUATION OF COVERAGE.  A notice of discontinuation of a health benefit plan must include a request to the group policyholder or other entity responsible for making payments or submitting subscription charges to the carrier to notify employees or members covered by the plan of the discontinuation and the date of the discontinuation.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter B. Discontinuation of Coverage › Section 1252.102. Extension of Benefits Provision; Exemption

Sec. 1252.102.  EXTENSION OF BENEFITS PROVISION;  EXEMPTION.  (a)  A health benefit plan must contain, subject to this section and Section 1252.103, a reasonable provision providing for an extension of benefits for a total disability that exists on the date of the plan's discontinuation.
(b)  A health benefit plan must contain a reasonable extension of benefits provision for coverage for hospital or medical expenses other than dental expenses.  A provision is considered reasonable if it provides to an individual who is covered under the plan and who is totally disabled on the date of the plan's discontinuation an extension of benefits for expenses incurred in treating the condition causing the total disability and the extension is provided for at least the lesser of:
(1)  90 days;  or
(2)  the duration of the total disability.
(c)  An extension of benefits provision required under this section may provide for an exclusion from coverage for an individual whose coverage is being discontinued and replaced with coverage that:
(1)  is provided by a succeeding carrier;  and
(2)  provides a level of benefits that is at least substantially equal to the level of benefits provided under the replaced health benefit plan.
(d)  An applicable extension of benefits provision must be described in the policy or contract and the group insurance certificate.
(e)  Benefits payable during an extension period may be subject to the regular benefit limits of the health benefit plan.
(f)  This section does not apply to a health benefit plan that was delivered or issued for delivery in this state before January 1, 1982, and whose level of benefits has not been modified after December 31, 1981.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter B. Discontinuation of Coverage › Section 1252.103. Indemnity or Benefits Payable for Disability

Sec. 1252.103.  INDEMNITY OR BENEFITS PAYABLE FOR DISABILITY.  A discontinuation of health benefit plan coverage occurring during a period of disability does not affect:
(1)  any benefits payable under the plan for loss of time from work because of the disability;  or
(2)  any specific indemnity required to be provided under the plan during a period of hospital confinement.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter B. Discontinuation of Coverage › Section 1252.104. Liability for Loss Under Automatically Discontinued Coverage

Sec. 1252.104.  LIABILITY FOR LOSS UNDER AUTOMATICALLY DISCONTINUED COVERAGE.  (a)  If a health benefit plan provides for automatic discontinuation of coverage when a premium or subscription charge due under the plan is not paid before the expiration of a grace period specified in the plan for that payment, the carrier or other entity responsible for making premium payments or for submitting premiums or subscription charges to the carrier is liable, on the submission of a valid claim, for a loss that is:
(1)  covered by the plan;  and
(2)  incurred before the expiration of the grace period.
(b)  The commissioner may adopt reasonable rules necessary to implement this section.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.201. Total Disability Status

Sec. 1252.201.  TOTAL DISABILITY STATUS.  In this subchapter, a reference to the total disability status of an individual means the individual's disability status immediately preceding the date on which the succeeding carrier's coverage takes effect.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.202. Effective Date of Coverage Under Replacement Plan

Sec. 1252.202.  EFFECTIVE DATE OF COVERAGE UNDER REPLACEMENT PLAN.  (a)  An individual who was covered by a previous carrier's health benefit plan on the date on which that plan was discontinued shall be provided coverage under the succeeding carrier's health benefit plan as of the replacement plan's effective date if the individual:
(1)  is eligible for coverage because the individual is a member of a class eligible for coverage under the replacement plan and satisfies the replacement plan's actively at work and nonconfinement requirements;  and
(2)  elects to be covered under the replacement plan.
(b)  An individual who would be covered by the succeeding carrier under Subsection (a) but who does not satisfy the replacement plan's actively at work and nonconfinement requirements shall be covered under the replacement plan when the individual satisfies those requirements.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.203. Extension of Benefits for Total Disability

Sec. 1252.203.  EXTENSION OF BENEFITS FOR TOTAL DISABILITY.  (a)  With respect to providing a type of coverage for which Section 1252.102 requires an extension of benefits for an individual with a total disability, a succeeding carrier replacing a previous carrier's plan that is not subject to that section must provide, subject to Subsection (b), the lesser of:
(1)  extended benefit coverage that the previous carrier would have been required to provide under Section 1252.102 if the previous carrier had been subject to that section;  or
(2)  extended benefit coverage that the succeeding carrier is required to provide under Section 1252.102.
(b)  The extended benefit coverage may be reduced by any benefits actually payable under the previous carrier's health benefit 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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.204. Coverage for Preexisting Conditions

Sec. 1252.204.  COVERAGE FOR PREEXISTING CONDITIONS.  (a)  A succeeding carrier's health benefit plan that limits coverage in accordance with a preexisting conditions provision, other than a waiting period, must provide, during the period the limitation on coverage is in effect, the level of benefits prescribed by this section to an individual covered by the succeeding carrier who:
(1)  has a preexisting condition;  and
(2)  was covered by the previous carrier's plan on the date on which that plan was discontinued.
(b)  The health benefit plan must provide a level of benefits equal to the lesser of:
(1)  the level of benefits available under the succeeding carrier's plan as determined without applying the preexisting conditions provision;  or
(2)  the level of benefits that would have been available under the previous carrier's 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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.205. Waiting Period

Sec. 1252.205.  WAITING PERIOD.  If the benefits that were available under a previous carrier's health benefit plan are similar to the benefits available under a succeeding carrier's health benefit plan, the succeeding carrier shall give credit for the satisfaction or partial satisfaction of any waiting period or similar provision that has been satisfied under the previous carrier's 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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.206. Determination of Benefits Available Under Replaced Plan

Sec. 1252.206.  DETERMINATION OF BENEFITS AVAILABLE UNDER REPLACED PLAN.  (a)  If a succeeding carrier requires a determination of the benefits available under the previous carrier's health benefit plan, the previous carrier shall provide at the request of the succeeding carrier:
(1)  a statement of the benefits available under the previous carrier's plan;  or
(2)  pertinent information sufficient either to allow verification of those benefits or to allow the succeeding carrier to make a determination of those benefits.
(b)  A determination of benefits under this section must be made using the definitions of, and in accordance with all of the conditions and covered expense provisions of, the previous carrier's plan as if that plan had not been replaced.
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 B - Group Health Coverage › Chapter 1252 - Discontinuation and Replacement of Group and Group-Type Health Benefit Plan Coverage › Subchapter C. Replacement of Coverage › Section 1252.207. Liability of Previous Carrier

Sec. 1252.207.  LIABILITY OF PREVIOUS CARRIER.  A carrier of a health benefit plan that is being discontinued is liable only for any accrued liabilities regarding the plan and for any extension of benefits provided under the plan, regardless of whether the group policyholder or any other entity responsible for making payments or for submitting subscription charges to the carrier:
(1)  replaces the coverage provided under the discontinued plan with health benefit plan coverage provided by another carrier;
(2)  self-insures a health benefit plan;  or
(3)  does not provide health benefit plan 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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter A. General Provisions › Section 1253.001. Limitation of Services and Benefits on Contract Renegotiation

Sec. 1253.001.  LIMITATION OF SERVICES AND BENEFITS ON CONTRACT RENEGOTIATION.  (a)  In this section, "health benefit contract" means a contract providing group health care coverage for employees that is delivered, issued for delivery, or renewed in this state by:
(1)  an insurance company;
(2)  a group hospital service corporation operating under Chapter 842;  or
(3)  a health maintenance organization operating under Chapter 843.
(b)  Subject to Subsection (c), if an employer in this state agrees to renegotiate a health benefit contract, a change in the renegotiated contract may not operate solely to terminate eligibility with respect to any member of the group who, before the contract was renegotiated:
(1)  was covered under the contract;  and
(2)  had a sickness or injury for which a service was being provided or a benefit was being paid under the contract.
(c)  A renegotiated health benefit contract may include a different durational or dollar limit or a different deductible amount or amount of coinsurance applicable to a sickness or injury for which a service was being provided or benefit was being paid before the contract was renegotiated if that same or a similar limit or amount applies to a service provided or benefit paid for a similar sickness or a related condition or injury covered by the contract.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.051. Applicability of Subchapter

Sec. 1253.051.  APPLICABILITY OF SUBCHAPTER.  This subchapter applies to a group accident and health insurance policy that is delivered or issued for delivery in this state and as to which any part of the premium is paid or is to be paid by an employer under the terms of a collective bargaining agreement.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.052. Continuation of Group Accident and Health Insurance During Labor Dispute Required for Certain Policies

Sec. 1253.052.  CONTINUATION OF GROUP ACCIDENT AND HEALTH INSURANCE DURING LABOR DISPUTE REQUIRED FOR CERTAIN POLICIES.  An insurer may not deliver or issue for delivery a policy subject to this subchapter unless the policy provides that if the employees covered by the policy stop work because of a labor dispute, coverage continues under the policy, on timely payment of the premium, for each employee who:
(1)  is covered under the policy on the date the work stoppage begins;
(2)  continues to pay the employee's individual contribution, subject to the conditions provided by this subchapter;  and
(3)  assumes and pays during the work stoppage the contribution due from the employer, subject to the conditions provided by this subchapter.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.053. Contributions if Policyholder Is Trustee

Sec. 1253.053.  CONTRIBUTIONS IF POLICYHOLDER IS TRUSTEE.  (a)  An employee's contribution for purposes of a policy as to which the policyholder is a trustee or the trustees of a fund established or maintained wholly or partly by the employer is the amount the employee and employer would have been required to contribute to the fund for the employee if:
(1)  the work stoppage had not occurred;  and
(2)  the agreement requiring the employer to make contributions to the fund were in effect.
(b)  The policy may provide that continuation of coverage is contingent on the collection of individual contributions by the policyholder or the policyholder's agent.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.054. Contributions if Policyholder Is Not Trustee

Sec. 1253.054.  CONTRIBUTIONS IF POLICYHOLDER IS NOT TRUSTEE.  (a)  A policy as to which the policyholder is not a trustee or the trustees of a fund established or maintained in whole or in part by the employer must provide that the employee's individual contribution:
(1)  is the policy rate applicable:
(A)  on the date the work stoppage begins;  and
(B)  to an individual in the class to which the employee belongs as provided by the policy;  or
(2)  if the policy does not provide for a rate applicable to an individual, is an amount equal to the amount determined by dividing:
(A)  the total monthly premium in effect under the policy on the date the work stoppage begins;  by
(B)  the total number of insureds under the policy on that date.
(b)  The policy may provide that continuation of coverage under this subchapter is contingent on the collection of individual contributions by the union or unions representing the employees.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.055. Payment of Contribution and Premium

Sec. 1253.055.  PAYMENT OF CONTRIBUTION AND PREMIUM.  A policy may provide that continuation of coverage for an employee under the policy is contingent on timely payment of:
(1)  contributions by the employee;  and
(2)  the premium by the entity responsible for collecting the individual employee contributions.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.056. Past Due Premium

Sec. 1253.056.  PAST DUE PREMIUM.  (a)  A policy may provide that the continuation of coverage is contingent on payment of any premium that:
(1)  is unpaid on the date the work stoppage begins;  and
(2)  became due before the date the work stoppage begins.
(b)  A premium described by Subsection (a) must be paid before the date the next premium becomes due under the policy.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.057. Individual Premium Rate Increase

Sec. 1253.057.  INDIVIDUAL PREMIUM RATE INCREASE.  (a)  A policy may provide that, during the period of a work stoppage, each individual premium rate shall be increased by an amount not to exceed 20 percent of the amount shown in the policy, or a greater percentage as approved by the commissioner, to provide sufficient compensation to the insurer to cover increased:
(1)  administrative costs;  and
(2)  mortality and morbidity.
(b)  If a policy provides for a premium rate increase in accordance with this section, the amount of an employee's contribution must be increased by the same percentage.
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 B - Group Health Coverage › Chapter 1253 - Cancellation of Group Coverage in Certain Circumstances › Subchapter B. Continuation of Group Accident and Health Insurance Policies During Labor Dispute › Section 1253.058. Premium Rate Change Not Limited

Sec. 1253.058.  PREMIUM RATE CHANGE NOT LIMITED.  (a)  This subchapter does not limit any right of the insurer under a policy to increase or decrease a premium rate before, during, or after a work stoppage if the insurer would be entitled to increase the premium rate had a work stoppage not occurred.
(b)  A change in a premium rate made in accordance with this section takes effect on a date that is determined by the insurer in accordance with the terms of the policy.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.