Title IN, Insurance Code

Sec. 1358.051. DEFINITIONS. In this subchapter: (1) "Diabetes equipment" means: (A) blood glucose monitors, including noninvasive glucose monitors and glucose monitors designed to be used by blind individuals; (B) insulin pumps and associated appurtenances; (C) insulin infusion d…

Sec. 1358.052. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to a health benefit plan that: (1) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including: (A) an individual, group, blanket, or franc…

Sec. 1358.053. EXCEPTION. This subchapter does not apply to: (1) a plan that provides coverage: (A) only for a specified disease or another limited benefit; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period during which an emp…

Sec. 1358.054. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for the treatment of diabetes and conditions associated with diabetes must provide to each qualified enrollee coverage for: (1) diabetes equipment; (2) diabetes supplies; and (3) diabetes self-mana…

Sec. 1358.055. DIABETES SELF-MANAGEMENT TRAINING. (a) Diabetes self-management training must be provided by a health care practitioner or provider who is: (1) licensed, registered, or certified in this state to provide appropriate health care services; and (2) acting within the s…

Sec. 1358.056. COVERAGE FOR NEW OR IMPROVED EQUIPMENT AND SUPPLIES. A health benefit plan must provide coverage for new or improved diabetes equipment or supplies, including improved insulin or another prescription drug, approved by the United States Food and Drug Administration …

Sec. 1358.057. RULES. (a) The commissioner shall adopt rules necessary to implement this subchapter. (b) In adopting rules under this section, the commissioner may consult with the commissioner of public health and other appropriate entities. Added by Acts 2003, 78th Leg., ch. 12…

Sec. 1358.101. 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 i…

Sec. 1358.102. EXCEPTION. This subchapter does not apply to: (1) a health benefit plan that provides coverage: (A) only for a specified disease or for another single benefit; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period d…

Sec. 1358.103. LIMIT ON COST-SHARING REQUIREMENT. (a) In this section, "insulin" means a prescription drug that contains insulin and is used to treat diabetes. The term does not include an insulin drug that is administered to a patient intravenously. (b) A health benefit plan may…

Sec. 1358.104. FORMULARY REQUIREMENT. A health benefit plan must include at least one insulin from each therapeutic class in the plan's formulary. Added by Acts 2021, 87th Leg., R.S., Ch. 589 (S.B. 827), Sec. 1, eff. September 1, 2021.

Sec. 1359.001. DEFINITIONS. In this chapter: (1) "Heritable disease" means an inherited disease that may result in a physical or intellectual disability or death. (2) "Phenylketonuria" means an inherited condition that, if not treated, may cause a severe intellectual disability. …

Sec. 1359.002. APPLICABILITY OF CHAPTER. This chapter applies only to a group health benefit plan that is a group policy, contract, or certificate of health insurance or an evidence of coverage delivered, issued for delivery, or renewed in this state by: (1) an insurance company;…

Sec. 1359.003. COVERAGE REQUIRED. (a) A group health benefit plan must provide coverage for formulas necessary to treat phenylketonuria or a heritable disease. (b) The group health benefit plan must provide the coverage to the same extent that the plan provides coverage for drugs…

Sec. 1360.001. DEFINITION. In this chapter, "temporomandibular joint" includes the jaw and the craniomandibular joint. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Sec. 1360.002. APPLICABILITY OF CHAPTER. This chapter applies only to a group health benefit plan delivered or issued for delivery in this state that: (1) provides benefits for dental, medical, or surgical expenses incurred as a result of a health condition, accident, or sickness…

Sec. 1360.003. EXCEPTION. This chapter does not apply to: (1) a plan that provides coverage: (A) only for a specified disease or another limited benefit; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period during which an employ…

Sec. 1360.004. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for medically necessary diagnostic or surgical treatment of conditions affecting skeletal joints must provide comparable coverage for diagnostic or surgical treatment of conditions affecting the te…

Sec. 1360.005. DENTAL SERVICES COVERAGE NOT REQUIRED. (a) This chapter does not require a health benefit plan to provide coverage for dental services if dental services are not otherwise scheduled or provided as part of the coverage provided under the plan. (b) A health benefit p…

Sec. 1361.001. DEFINITION. In this chapter, "qualified enrollee" means an individual entitled to coverage under a group health benefit plan who is: (1) a postmenopausal woman who is not receiving estrogen replacement therapy; (2) an individual with: (A) vertebral abnormalities; (…

Sec. 1361.002. APPLICABILITY OF CHAPTER. This chapter applies only to a group health benefit plan delivered, issued for delivery, or renewed in this state that provides coverage for medical or surgical expenses incurred as a result of accident or sickness, including: (1) a group …

Sec. 1361.003. COVERAGE REQUIRED. A group health benefit plan must provide to a qualified enrollee coverage for medically accepted bone mass measurement to detect low bone mass and to determine the enrollee's risk of osteoporosis and fractures associated with osteoporosis. Added …

Sec. 1362.001. APPLICABILITY OF CHAPTER. This chapter applies only to a health benefit plan that: (1) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including: (A) an individual, group, blanket, or franchise i…

Sec. 1362.002. EXCEPTION. This chapter does not apply to: (1) a health benefit plan that provides coverage: (A) only for a specified disease or for another limited benefit; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period dur…

Sec. 1362.003. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for diagnostic medical procedures must provide to each male enrolled in the plan coverage for expenses for an annual medically recognized diagnostic examination for the detection of prostate cancer…

Sec. 1362.004. NOTICE OF COVERAGE. (a) A health benefit plan issuer shall provide to each individual enrolled in the plan written notice of the coverage required under this chapter. (b) The notice must be provided in accordance with rules adopted by the commissioner. Added by Act…

Sec. 1362.005. RULES. The commissioner shall adopt rules necessary to administer this chapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Sec. 1363.001. APPLICABILITY OF CHAPTER. This chapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage that is provided by a health group cooperative under Subchapter B of that chapter, that: (1) provides…

Sec. 1363.002. EXCEPTION. This chapter does not apply to: (1) a plan that provides coverage: (A) only for a specified disease or other limited benefit; (B) only for accidental death or dismemberment; (C) for wages or payments in lieu of wages for a period during which an employee…

Sec. 1363.003. MINIMUM COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for screening medical procedures must provide to each individual enrolled in the plan who is 45 years of age or older and at normal risk for developing colon cancer coverage for expenses in…

Sec. 1363.004. NOTICE OF COVERAGE. (a) A health benefit plan issuer shall provide to each individual enrolled in the plan written notice of the coverage required under this chapter. (b) The notice must be provided in accordance with rules adopted by the commissioner. Added by Act…

Sec. 1363.005. RULES. The commissioner shall adopt rules as necessary to administer this chapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Sec. 1364.001. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to a group health benefit plan that is delivered, issued for delivery, or renewed and that is: (1) a group accident and health insurance policy; (2) a group contract issued by a group hospital service corpor…

Sec. 1364.002. EXCEPTION. This subchapter does not apply to: (1) a credit accident and health insurance policy subject to Chapter 1153; (2) any group specifically provided for or authorized by law in existence and covered under a policy filed with the State Board of Insurance bef…

Sec. 1364.003. PROHIBITION. A group health benefit plan may not exclude or deny coverage for: (1) human immunodeficiency virus (HIV); (2) acquired immune deficiency syndrome (AIDS); or (3) an HIV-related illness. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005…

Sec. 1364.004. RULES. The commissioner may adopt rules necessary to administer this subchapter. A rule adopted under this section is subject to notice and hearing as provided by Section 1201.007 for a rule adopted under Chapter 1201. Added by Acts 2003, 78th Leg., ch. 1274, Sec. …

Sec. 1364.051. DEFINITIONS. In this subchapter, "AIDS" and "HIV" have the meanings assigned by Section 81.101, Health and Safety Code. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Sec. 1364.052. APPLICABILITY OF SUBCHAPTER. This subchapter applies to an insurer that delivers or issues for delivery a group health insurance policy or contract in this state, including a group hospital service corporation operating under Chapter 842. Added by Acts 2003, 78th L…

Sec. 1364.053. PROHIBITION. (a) Except as provided by Subsection (b), an insurer may not cancel during the term of a group health insurance policy or contract an individual's coverage provided by the policy or contract because the individual: (1) has been diagnosed as having AIDS…

Sec. 1364.101. PROHIBITION ON EXCLUSION OR LIMITATION OF COVERAGES. A political subdivision that provides group health insurance coverage, health maintenance organization coverage, or self-insured health care coverage to the political subdivision's officers or employees may not c…

Sec. 1365.001. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to a group health benefit plan that provides hospital and medical coverage on an expense-incurred, service, or prepaid basis, including a group policy, contract, or plan that is offered in this state by: (1)…

Sec. 1365.002. APPLICABILITY OF GENERAL PROVISIONS OF OTHER LAW. The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, construction of policies under that chapter, rulemaking under that chapter, and definitio…

Sec. 1365.003. OFFER OF COVERAGE REQUIRED. (a) A group health benefit plan issuer shall offer and make available under the plan coverage for the necessary care and treatment of loss or impairment of speech or hearing. (b) Coverage required under this section: (1) may not be less …

Sec. 1365.004. RIGHT TO REJECT COVERAGE OR SELECT ALTERNATIVE BENEFITS. An offer of coverage required under Section 1365.003 is subject to the right of the group contract holder to reject the coverage or to select an alternative level of benefits that is offered by or negotiated …

Sec. 1365.051. APPLICABILITY. (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 polic…

Sec. 1365.052. EXCEPTION. This subchapter does not apply to: (1) a plan that provides coverage: (A) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury; or (B) only for hospital expenses; or (2) the state …