Texas Administrative Code › Title 28 - INSURANCE › Part 1 - TEXAS DEPARTMENT OF INSURANCE › Chapter 26 - EMPLOYER-RELATED HEALTH BENEFIT PLAN REGULATIONS › Subchapter D - COOPERATIVES › Division 1 - NONPROFIT HEALTH GROUP COOPERATIVES › Section 26.409 - Health Benefit Plans Offered Through Health Group Cooperatives

Current through Reg. 49, No. 28; July 12, 2024
(a) A health benefit plan issued by a health
					 carrier through a health group cooperative is not subject to the following
					 provisions of the Insurance Code or this title:
(1) the offer of in vitro fertilization
					 coverage as required by Insurance Code Chapter 1366, Subchapter A (Coverage for
					 In Vitro Fertilization Procedures);
(2) coverage of HIV, AIDS, or HIV-related
					 illnesses as required by Insurance Code Chapter 1364, Subchapter A (concerning
					 Exclusion from or Denial of Coverage Prohibited);
(3) coverage of chemical dependency and stays
					 in a chemical dependency treatment facility as required by Insurance Code
					 Chapter 1368 (concerning Availability of Chemical Dependency
					 Coverage);
(4) coverage or offer of
					 coverage of serious mental illness as required by Insurance Code §§
												1355.001 -
					 1355.007
					 (concerning Definitions, Applicability of Subchapter, Exception, Required
					 Coverage for Serious Mental Illness, Managed Care Plan Authorized, Coverage for
					 Certain Conditions Related to Controlled Substance or Marihuana Not Required,
					 Small Employer Coverage);
(5) the
					 offer of mental or emotional illness coverage as required by Insurance Code
					 §
												1355.106
					 (concerning Offer of Coverage Required; Alternative Benefits);
(6) coverage of inpatient mental health and
					 stays in a psychiatric day treatment facility as required by Insurance Code
					 Chapter 1355, Subchapter C (concerning Psychiatric Day Treatment
					 Facilities);
(7) the offer of
					 speech and hearing coverage as required by Insurance Code Chapter 1365
					 (concerning Loss or Impairment of Speech or Hearing);
(8) coverage of mammography screening for the
					 presence of occult breast cancer as required by Insurance Code §
												1356.005
					 (concerning Coverage Required);
(9)
					 standards for proof of Alzheimer's disease as required by Insurance Code §
												1354.002
					 (concerning Proof of Organic Disease);
(10) coverage of stays in a crisis
					 stabilization unit or residential treatment center for children and adolescents
					 as required by Insurance Code §
												1355.055
					 (concerning Determinations for Treatment in a Residential Treatment Center for
					 Children and Adolescents) and §1355.056 (concerning Determinations for
					 Treatment by a Crisis Stabilization Unit);
(11) coverage for formulas necessary for the
					 treatment of phenylketonuria as required by Insurance Code Chapter 1359
					 (concerning Formulas for Individuals with Phenylketonuria or Other Heritable
					 Diseases);
(12) coverage of
					 contraceptive drugs and devices as required by Insurance Code Chapter 1369,
					 Subchapter C (concerning Coverage of Prescription Contraceptive Drugs and
					 Devices and Related Services) and §
												21.404(3)
					 of this title (relating to Underwriting);
(13) coverage of diagnosis and treatment
					 affecting temporomandibular joint and treatment for a person unable to undergo
					 dental treatment in an office setting or under local anesthesia as required by
					 Insurance Code Chapter 1360 (concerning Diagnosis and Treatment Affecting
					 Temporomandibular Joint);
(14)
					 coverage of bone mass measurement for osteoporosis as required by Insurance
					 Code Chapter 1361 (concerning Detection and Prevention of
					 Osteoporosis);
(15) coverage of
					 diabetes care as required by Insurance Code Chapter 1358 (concerning
					 Diabetes);
(16) coverage of
					 childhood immunizations as required by Insurance Code Chapter 1367, Subchapter
					 B (concerning Childhood Immunizations);
(17) coverage for screening tests for hearing
					 loss in children and related diagnostic follow-up care as required by Insurance
					 Code Chapter 1367 Subchapter C (concerning Hearing Test);
(18) offer of coverage for therapies for
					 children with developmental delays as required by Insurance Code Chapter 1367,
					 Subchapter E (concerning Developmental Delays);
(19) coverage of certain tests for detection
					 of prostate cancer as required by Insurance Code Chapter 1362 (concerning
					 Certain Tests for Detection of Prostate Cancer);
(20) coverage of acquired brain injury
					 treatment and services as required by Insurance Code Chapter 1352 (concerning
					 Brain Injury);
(21) coverage of
					 certain tests for detection of colorectal cancer as required by Insurance Code
					 Chapter 1363 (concerning Certain Tests for Detection of Colorectal
					 Cancer);
(22) coverage for
					 reconstructive surgery for craniofacial abnormalities in a child as required by
					 Insurance Code Chapter 1367, Subchapter D (concerning Childhood Craniofacial
					 Abnormalities);
(23) coverage of
					 rehabilitation therapies as required by Insurance Code §
												1271.156
					 (concerning Benefits for Rehabilitation Services and Therapies);
(24) limitations on the treatment of
					 complications in pregnancy established by §
												21.405
					 of this title (relating to Policy Terms and Conditions);
(25) coverage for services related to
					 immunizations and vaccinations under managed care plans as required by
					 Insurance Code Chapter 1353 (concerning Immunization or Vaccination Protocols
					 under Managed Care Plans);
(26)
					 coverage of a minimum stay for maternity as required by Insurance Code Chapter
					 1366, Subchapter B (concerning Minimum Inpatient Stay Following Birth of Child
					 and Postdelivery Care);
(27)
					 coverage of reconstructive surgery incident to mastectomy as required by
					 Insurance Code Chapter 1357, Subchapter A (concerning Reconstructive Surgery
					 Following Mastectomy);
(28)
					 coverage of a minimum stay for mastectomy treatment and services as required by
					 Insurance Code Chapter 1357, Subchapter B (concerning Hospital Stay Following
					 Mastectomy and Certain Related Procedures);
(29) coverage of autism spectrum disorder as
					 required by the Insurance Code §
												1355.015
					 (concerning Required Coverage for Certain Enrollees);
(30) transplant donor coverage, as
					 established by 28 TAC §
												3.3040(h)
					 of this title (relating to Prohibited Policy Provisions);
(31) coverage for certain tests for detection
					 of human papillomavirus, ovarian cancer, and cervical cancer as required by
					 Insurance Code Chapter 1370 (concerning Certain Tests for Detection of Human
					 Papillomavirus, Ovarian Cancer, and Cervical Cancer);
(32) coverage of certain tests for detection
					 of cardiovascular disease as required by Insurance Code Chapter 1376
					 (concerning Certain Tests for Early Detection of Cardiovascular
					 Disease);
(33) coverage of certain
					 amino acid-based elemental formulas as required by Insurance Code Chapter 1377
					 (concerning Coverage for Certain Amino Acid-Based Elemental
					 Formulas);
(34) coverage of
					 prosthetic devices, orthotic devices, and related services as required by
					 Insurance Code Chapter 1371 (concerning Coverage for Certain Prosthetic
					 Devices, Orthotic Devices, and Related Services); and
(35) coverage of orally-administered
					 anticancer medications as required by Insurance Code Chapter 1369 (concerning
					 Benefits Related to Prescription Drugs and Devices and Related
					 Services).