2023 Texas Statutes › Insurance Code › Title 8 - Health Insurance and Other Health Coverages › Subtitle E - Benefits Payable Under Health Coverages › Chapter 1369 - Benefits Related to Prescription Drugs and Devices and Related Services › Subchapter E. -1. Coverage of Prescription Drugs for Stage-Four Advanced, Metastatic Cancer › Section 1369.212. Applicability of Subchapter

Sec. 1369.212.  APPLICABILITY OF SUBCHAPTER.  (a)  This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses or pharmacy benefits incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is issued by:
(1)  an insurance company;
(2)  a group hospital service corporation operating under Chapter 842;
(3)  a health maintenance organization operating under Chapter 843;
(4)  an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;
(5)  a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;
(6)  a stipulated premium company operating under Chapter 884;
(7)  a fraternal benefit society operating under Chapter 885;
(8)  a Lloyd's plan operating under Chapter 941; or
(9)  an exchange operating under Chapter 942.
Text of subsection effective until April 01, 2025
(b)  Notwithstanding any other law, this subchapter applies to:
(1)  a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;
(2)  a standard health benefit plan issued under Chapter 1507;
(3)  a basic coverage plan under Chapter 1551;
(4)  a basic plan under Chapter 1575;
(5)  a primary care coverage plan under Chapter 1579;
(6)  a plan providing basic coverage under Chapter 1601;
(7)  health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;
(8)  group health coverage made available by a school district in accordance with Section 22.004, Education Code;
(9)  the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;
(10)  the child health plan program under Chapter 62, Health and Safety Code;
(11)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and
(12)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
Text of subsection effective on April 01, 2025
(b)  Notwithstanding any other law, this subchapter applies to:
(1)  a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;
(2)  a standard health benefit plan issued under Chapter 1507;
(3)  a basic coverage plan under Chapter 1551;
(4)  a basic plan under Chapter 1575;
(5)  a primary care coverage plan under Chapter 1579;
(6)  a plan providing basic coverage under Chapter 1601;
(7)  health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;
(8)  group health coverage made available by a school district in accordance with Section 22.004, Education Code;
(9)  the state Medicaid program, including the Medicaid managed care program operated under Chapters 540 and 540A, Government Code;
(10)  the child health plan program under Chapter 62, Health and Safety Code;
(11)  a regional or local health care program operated under Section 75.104, Health and Safety Code; and
(12)  a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
(c)  This subchapter applies to coverage under a group health benefit plan provided to a resident of this state regardless of whether the group policy, agreement, or contract is delivered, issued for delivery, or renewed in this state.
Added by Acts 2019, 86th Leg., R.S., Ch. 1350 (H.B. 1584), Sec. 1, eff. September 1, 2019.
Amended by:
Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611), Sec. 2.126, eff. April 1, 2025.