Tex.
Ins. Code Section 1369.452
Applicability of Subchapter
(a)
This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses 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 offered by:(1)
an insurance company;(2)
a group hospital service corporation operating under Chapter 842 (Group Hospital Service Corporations);(3)
a health maintenance organization operating under Chapter 843 (Health Maintenance Organizations);(4)
an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations);(5)
a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements);(6)
a stipulated premium company operating under Chapter 884 (Stipulated Premium Insurance Companies);(7)
a fraternal benefit society operating under Chapter 885 (Fraternal Benefit Societies); or(8)
an exchange operating under Chapter 942 (Reciprocal and Interinsurance Exchanges).(b)
This subchapter applies to group health coverage made available by a school district in accordance with Section 22.004 (Group Health Benefits for School Employees), Education Code.(c)
Notwithstanding any provision in Chapter 1551 (Texas Employees Group Benefits Act), 1575 (Texas Public School Employees Group Benefits Program), 1579 (Texas School Employees Uniform Group Health Coverage), or 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System) or any other law, this subchapter applies to health benefit plan coverage provided under:(1)
Chapter 1551 (Texas Employees Group Benefits Act);(2)
Chapter 1575 (Texas Public School Employees Group Benefits Program);(3)
Chapter 1579 (Texas School Employees Uniform Group Health Coverage); and(4)
Chapter 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System).(d)
Notwithstanding Section 1501.251 (Exception from Certain Mandated Benefit Requirements) or any other law, this subchapter applies to coverage under a small employer health benefit plan subject to Chapter 1501 (Health Insurance Portability and Availability Act).(e)
This subchapter applies to a standard health benefit plan issued under Chapter 1507 (Consumer Choice of Benefits Plans).(f)
To the extent allowed by federal law, the child health plan program operated under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code, and the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code, shall provide the coverage required under this subchapter to a recipient.(f)
To the extent allowed by federal law, the child health plan program operated under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code, and the state Medicaid program, including the Medicaid managed care program operated under Chapters 540 (Medicaid Managed Care Program) and 540A (Medicaid Managed Transportation Services), Government Code, shall provide the coverage required under this subchapter to a recipient.
Source:
Section 1369.452 — Applicability of Subchapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1369.htm#1369.452 (accessed Jun. 5, 2024).
