Preconditions For Payment; Exceptions

Sec. 1204.252. PRECONDITIONS FOR PAYMENT; EXCEPTIONS. (a) In accordance with the terms of the policy and this subchapter, an insurer or group hospital service corporation may be required to pay benefits under a group accident and health insurance policy to a person who is not a group member and who complies with: (1) Section 1204.251; (2) the insurer's or group hospital service corporation's claim application procedures; and (3) department rules. (b) Any requirement imposed on a possessory or managing conservator of a child under this subchapter does not apply with regard to: (1) an unpaid medical bill for which an assignment of benefits has been exercised, whether in accordance with policy provisions or otherwise; or (2) a claim presented by a group member for which the group member paid any portion of a medical bill that is covered under the policy's terms. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.