Tex. Ins. Code Section 1251.108
Exclusion or Limitation of Coverage for Preexisting Conditions

(a)

A group accident and health insurance policy must specify the additional exclusions or limitations, if any, applicable under the policy with respect to a disease or physical condition of an insured, not otherwise excluded from the insured’s coverage by name or specific description effective on the date of the insured’s loss, that existed before the effective date of the insured’s coverage under the policy.

(b)

An exclusion or limitation described by Subsection (a) may apply only to a disease or physical condition for which the insured received medical advice or treatment during the 12 months before the effective date of the insured’s coverage.

(c)

An exclusion or limitation described by Subsection (a) may not apply to a loss incurred or disability beginning after the earlier of:

(1)

the end of 12 consecutive months, beginning on or after the effective date of the insured’s coverage, during which the insured has not received medical advice or treatment in connection with the disease or physical condition; or

(2)

the second anniversary of the effective date of the insured’s coverage.

(d)

This section does not apply to:

(1)

a credit accident and health insurance policy; or

(2)

a group accident and health insurance policy subject to Chapter 1501 (Health Insurance Portability and Availability Act).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1251.108 — Exclusion or Limitation of Coverage for Preexisting Conditions, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1251.­htm#1251.­108 (accessed Jun. 5, 2024).

1251.001
Definitions 1251.002
Certain Group Health Insurance Authorized 1251.003
Certain Blanket Health Insurance Authorized 1251.004
Certain Payments by Insurers Prohibited 1251.005
Payment of Benefits 1251.006
Policy May Not Specify Service Provider 1251.007
Exceptions 1251.008
Rules 1251.051
Employers 1251.052
Associations 1251.053
Funds Established by Employers, Labor Unions, or Associations 1251.054
Eligibility for Group Life Insurance 1251.055
Fund for Former Employees and Members 1251.056
Other Groups 1251.101
Required Provisions 1251.102
Payment of Premiums 1251.103
Incontestability of Policy 1251.104
Entire Contract 1251.105
Statement Made by Policyholder or Insured 1251.106
Distinction Based on Marital Status Prohibited 1251.107
Evidence of Insurability 1251.108
Exclusion or Limitation of Coverage for Preexisting Conditions 1251.109
Adjustment of Premiums or Benefits if Age of Insured Is Misstated 1251.110
Deadline for Notice of Claim 1251.111
Claim Forms 1251.112
Deadline for Claim 1251.113
Prompt Payment of Benefits Required 1251.114
Payment of Benefits 1251.115
Right to Conduct Physical Examination or Autopsy 1251.116
Legal or Equitable Actions 1251.117
Continuation or Conversion of Coverage 1251.151
Coverage for Certain Grandchildren 1251.152
Optional Coverage for Spouses and Dependents 1251.153
Optional Continuation of Dependents’ Benefits on Death of Insured 1251.154
Coverage for Adopted Children 1251.201
Certificate of Insurance 1251.202
Notice Regarding Certain Employer Health Benefit Plans 1251.251
Continuation of Group Coverage Required 1251.252
Eligibility for Continuation of Group Coverage 1251.253
Request for Continuation of Group Coverage 1251.254
Payment of Contributions 1251.255
Termination of Continued Coverage 1251.256
Conversion of Group Policy 1251.257
Premium for Converted Policy 1251.258
Benefits Under Converted Policy 1251.259
Termination of Converted Policy 1251.260
Notice of Continuation and Conversion Privileges 1251.301
Continuation of Group Coverage 1251.302
Eligibility for Continued Coverage 1251.303
Physical Examination Not Required 1251.304
Scope of Coverage 1251.305
Amount of Premium 1251.306
Payment of Premiums 1251.307
Notice of Continuation Option 1251.308
Notice of Severance of Family Relationship 1251.309
Continuation of Certain Coverages 1251.310
Termination of Continued Coverage 1251.351
Common Carrier or Motor Vehicle Rental or Leasing Company 1251.352
Employers 1251.353
Educational Institutions 1251.354
Religious, Charitable, Recreational, Educational, or Civic Organization 1251.355
Sports Team or Camp 1251.356
Governmental or Volunteer Emergency Services Organization 1251.357
Newspaper or Other Publisher 1251.358
Association 1251.359
Coverage for Other Risks 1251.401
Individual Application and Certificate Not Required 1251.402
Liability of Policyholder Not Affected 1251.451
Applicability of Certain Laws to Out-of-state Group Accident and Health Insurance Coverage
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 1251.108’s source at texas​.gov