Law:Title 8. Health Insurance And Other Health Coverages. Subtitle A. Health Coverage In General from Chapter 1203. Coordination Of Benefits Provisions (Texas)

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Subtitle A. Health Coverage In General

Contents

Chapter 1203. Coordination Of Benefits Provisions

Section  1203.001.  Applicability Of Chapter.

(a) This chapter applies only to:

(1)  a policy of group accident and health insurance as described by Chapter 1251;

(2)  a policy of blanket accident and health insurance as described by Chapter 1251;

(3)  a policy of individual accident and health insurance as defined by Section 1201.001; or

(4)  an evidence of coverage as defined by Section 843.002.

(b)  This chapter does not apply to an individual accident and health insurance policy that is designed to fully integrate with other policies through a variable deductible.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.



Section  1203.002.  Certain Coordination Of Benefits Provisions Prohibited.

(a) An accident and health insurance policy or evidence of coverage may not be delivered, issued for delivery, or renewed in this state if:

(1)  a provision of the policy or evidence of coverage excludes or reduces the payment of benefits to or on behalf of an insured or enrollee;

(2)  the reason for the exclusion or reduction is that benefits are also payable or have been paid to or on behalf of the insured or enrollee under a supplemental policy of accident and health insurance; and

(3)  the supplemental policy is individually underwritten and individually issued as a plan of coverage for:

(A)  hospital confinement indemnity;

(B)  a specified disease; or

(C)  a limited benefit.

(b)  Application of Subsection (a) to a provision of an accident and health insurance policy or evidence of coverage is not affected by:

(1)  the mode or channel by which the premium for a supplemental policy of accident and health insurance is paid to the insurer; or

(2)  a reduction in the premium for a supplemental policy of accident and health insurance because of the insured's membership in an organization or status as an employee.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.



Section  1203.003.  Certain Coordination Of Benefits Provisions Void.

A provision of an accident and health insurance policy or evidence of coverage that violates Section 1203.002 is void.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.


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