Title IN, Insurance Code

Sec. 1366.004. REJECTION OF OFFER. A rejection of an offer under Section 1366.003 to provide coverage for in vitro fertilization procedures must be in writing. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Sec. 1366.005. CONDITIONS APPLICABLE TO COVERAGE. The coverage offered under Section 1366.003 is required only if: (1) the patient for the in vitro fertilization procedure is an individual covered under the group health benefit plan; (2) the fertilization or attempted fertilizati…

Sec. 1366.006. CERTAIN ISSUERS OF HEALTH BENEFIT PLANS NOT REQUIRED TO OFFER COVERAGE. An insurer, health maintenance organization, or self-insuring employer that is owned by or that is part of an entity, group, or order that is directly affiliated with a bona fide religious deno…

Sec. 1366.007. 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. 1366.051. SHORT TITLE. This subchapter may be cited as the Lee Alexandria Hanley Act. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

Sec. 1366.052. DEFINITIONS. In this subchapter: (1) "Attending physician" means an obstetrician, pediatrician, or other physician who attends a woman who has given birth to a child or who attends a newborn child. (2) "Postdelivery care" means postpartum health care services provi…

Sec. 1366.053. 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. 1366.054. EXCEPTION. This subchapter does not apply to: (1) a 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 during which an…

Sec. 1366.055. COVERAGE FOR INPATIENT CARE REQUIRED. (a) Except as provided by Subsection (b), a health benefit plan that provides maternity benefits, including benefits for childbirth, must provide to a woman who has given birth to a child and the newborn child coverage for inpa…

Sec. 1366.056. COVERAGE FOR POSTDELIVERY CARE REQUIRED. (a) If a decision is made to discharge a woman who has given birth to a child or the newborn child from inpatient care before the expiration of the minimum hours of coverage required under Section 1366.055(a), a health benef…

Sec. 1366.057. PROHIBITED CONDUCT. An issuer of a health benefit plan may not: (1) modify the terms and conditions of coverage based on a request by an enrollee for less than the minimum coverage required under Section 1366.055(a); (2) offer to a woman who has given birth to a ch…

Sec. 1366.058. NOTICE OF COVERAGE. (a) An issuer of a health benefit plan shall provide to each individual enrolled in the plan written notice of the coverage required under this subchapter. (b) The notice must be provided in accordance with rules adopted by the commissioner. Add…

Sec. 1366.059. RULES. The commissioner shall adopt rules necessary to administer this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. SUBCHAPTER C. COVERAGE FOR CERTAIN FERTILITY PRESERVATION SERVICES

Sec. 1366.101. DEFINITION. In this subchapter, "fertility preservation services": (1) means the collection and preservation of sperm, unfertilized oocytes, and ovarian tissue; and (2) does not include the storage of such unfertilized genetic materials. Added by Acts 2023, 88th Le…

Sec. 1366.102. 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. 1366.103. EXCEPTIONS. This subchapter does not apply to: (1) a health benefit 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; (…

Sec. 1366.104. REQUIRED COVERAGE. (a) Subject to Subsection (b), a health benefit plan must provide coverage for fertility preservation services to a covered person who will receive a medically necessary treatment for cancer, including surgery, chemotherapy, or radiation, that th…

Sec. 1367.001. APPLICABILITY OF SUBCHAPTER. This subchapter applies only to a health benefit plan delivered or issued for delivery in this state that is an individual or group policy of accident and health insurance, including a policy issued by a group hospital service corporati…

Sec. 1367.002. 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. 1367.003. CERTAIN LIMITATIONS ON COVERAGE FOR NEWBORN CHILDREN PROHIBITED. A health benefit plan that provides maternity benefits or accident and health coverage for additional newborn children may not be issued in this state if the plan excludes or limits: (1) initial cover…

Sec. 1367.051. 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 an individual, group, blanket, or franchise …

Sec. 1367.052. EXCEPTION. This subchapter does not apply to: (1) a 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 during which an…

Sec. 1367.053. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for a family member of an insured or enrollee shall provide for each covered child from birth through the date of the child's sixth birthday coverage for: (1) immunization against: (A) diphtheria; …

Sec. 1367.054. COPAYMENT, DEDUCTIBLE, OR COINSURANCE REQUIREMENT PROHIBITED. (a) Coverage required under Section 1367.053(a) may not be made subject to a deductible, copayment, or coinsurance requirement. (b) This section does not prohibit the application of a deductible, copayme…

Sec. 1367.055. RULES. The commissioner may adopt rules necessary to implement this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. Amended by: Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.039, eff. September 1, 2005. SUBCHAPTER C. HEARING TE…

Sec. 1367.101. APPLICABILITY OF SUBCHAPTER. (a) 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 an individual, group, blanket, or franch…

Sec. 1367.102. EXCEPTION. This subchapter does not apply to: (1) a 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 during which an…

Sec. 1367.103. COVERAGE REQUIRED. (a) A health benefit plan that provides coverage for a family member of an insured or enrollee shall provide to each covered child coverage for: (1) a screening test for hearing loss from birth through the date the child is 30 days of age, as pro…

Sec. 1367.104. COPAYMENT OR COINSURANCE REQUIREMENT PERMITTED; DEDUCTIBLE REQUIREMENT OR DOLLAR LIMIT PROHIBITED; NOTICE REQUIRED. (a) Coverage required under this subchapter: (1) may be subject to a copayment or coinsurance requirement; and (2) may not be subject to a deductible…

Sec. 1367.105. RULES. The commissioner may adopt rules necessary to implement this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. SUBCHAPTER D. CHILD CRANIOFACIAL ABNORMALITIES

Sec. 1367.151. 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. 1367.152. EXCEPTION. This subchapter does not apply to: (1) a 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 during which an…

Sec. 1367.153. RECONSTRUCTIVE SURGERY FOR CRANIOFACIAL ABNORMALITIES; DEFINITION REQUIRED. A health benefit plan that provides coverage for a child who is younger than 18 years of age must define "reconstructive surgery for craniofacial abnormalities" under the plan to mean surge…

Sec. 1367.154. RULES. The commissioner shall adopt rules necessary to administer this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005. SUBCHAPTER E. DEVELOPMENTAL DELAYS

Sec. 1367.201. DEFINITION. In this subchapter, rehabilitative and habilitative therapies include: (1) occupational therapy evaluations and services; (2) physical therapy evaluations and services; (3) speech therapy evaluations and services; and (4) dietary or nutritional evaluati…

Sec. 1367.202. 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 an individual, group, blanket, or franchise …

Sec. 1367.203. EXCEPTION. This subchapter does not apply to: (1) a 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 during which an…

Sec. 1367.204. OFFER OF COVERAGE REQUIRED. (a) A health benefit plan issuer must offer coverage that complies with this subchapter. (b) The individual or group policy or contract holder may reject coverage required to be offered under this section. Added by Acts 2005, 79th Leg., …

Sec. 1367.205. COVERAGE OF CERTAIN THERAPIES. (a) A health benefit plan that provides coverage for rehabilitative and habilitative therapies under this subchapter may not prohibit or restrict payment for covered services provided to a child and determined to be necessary to and p…

Sec. 1367.206. PROHIBITED ACTIONS. Under the coverage required to be offered under this subchapter, a health benefit plan issuer may not: (1) apply the cost of rehabilitative and habilitative therapies described by Section 1367.205(a) to an annual or lifetime maximum plan benefit…

Sec. 1367.207. RULES. The commissioner may adopt rules necessary to implement this subchapter. Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.040(a), eff. September 1, 2005. SUBCHAPTER F. HEARING AIDS AND COCHLEAR IMPLANTS

Sec. 1367.251. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage provided through a health group cooperative under Subchapter B of that chapter, that provid…

Sec. 1367.252. 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; (B) as a supplement to a liability insurance policy;…

Sec. 1367.253. COVERAGE REQUIRED. (a) A health benefit plan must provide coverage for the cost of a medically necessary hearing aid or cochlear implant and related services and supplies for a covered individual who is 18 years of age or younger. (b) Coverage required under this s…

Sec. 1367.301. 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. 1367.302. COVERAGE FOR GENERAL ANESTHESIA. Subject to Section 1360.005, a health benefit plan that provides coverage for general anesthesia may not exclude from coverage medically necessary general anesthesia services in connection with dental services provided to a covered …