Tex. Ins. Code Section 1355.004
Required Coverage for Serious Mental Illness

(a)

A group health benefit plan:

(1)

must provide coverage, based on medical necessity, for not less than the following treatments of serious mental illness in each calendar year:

(A)

45 days of inpatient treatment; and

(B)

60 visits for outpatient treatment, including group and individual outpatient treatment;

(2)

may not include a lifetime limitation on the number of days of inpatient treatment or the number of visits for outpatient treatment covered under the plan; and

(3)

must include the same amount limitations, deductibles, copayments, and coinsurance factors for serious mental illness as the plan includes for physical illness.

(b)

A group health benefit plan issuer:

(1)

may not count an outpatient visit for medication management against the number of outpatient visits required to be covered under Subsection (a)(1)(B); and

(2)

must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Source: Section 1355.004 — Required Coverage for Serious Mental Illness, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1355.­htm#1355.­004 (accessed Jun. 5, 2024).

1355.001
Definitions 1355.002
Applicability of Subchapter 1355.003
Exception 1355.004
Required Coverage for Serious Mental Illness 1355.005
Managed Care Plan Authorized 1355.006
Coverage for Certain Conditions Related to Controlled Substance or Marihuana Not Required 1355.007
Small Employer Coverage 1355.015
Required Coverage for Certain Enrollees 1355.051
Definitions 1355.052
Applicability of Subchapter 1355.053
Required Coverage for Certain Illnesses and Disorders 1355.054
Conditions for Coverage 1355.055
Determinations for Treatment in a Residential Treatment Center for Children and Adolescents 1355.056
Determinations for Treatment by a Crisis Stabilization Unit 1355.057
Review and Adjustment of Minimum Ratios of Reimbursement 1355.058
Health and Human Services Commission Assistance 1355.101
Definition 1355.102
Applicability of Subchapter 1355.103
Applicability of General Provisions of Other Law 1355.104
Required Coverage for Treatment in Psychiatric Day Treatment Facility 1355.105
Determinations for Treatment in Psychiatric Day Treatment Facility 1355.106
Offer of Coverage Required 1355.151
Prohibition on Exclusion or Limitation of Certain Coverages 1355.201
Applicability of General Provisions of Other Law 1355.202
Prohibition of Exclusion of Mental Health or Intellectual Disability Benefits for Treatment by Tax-supported Institution 1355.251
Definitions 1355.252
Applicability of Subchapter 1355.253
Exceptions 1355.254
Coverage for Mental Health Conditions and Substance Use Disorders 1355.255
Compliance 1355.256
Definitions Under Plan 1355.257
Coordination with Other Law 1355.258
Rules 1355.2571
Parity Complaint Portal 1355.2572
Educational Materials and Parity Law Training
Green check means up to date. Up to date

Accessed:
Jun. 5, 2024

§ 1355.004’s source at texas​.gov