Sec. 1507.053. STATE-MANDATED HEALTH BENEFITS. (a) For purposes of this subchapter, "state-mandated health benefits" means coverage required under this code or other laws of this state to be provided in an evidence of coverage that:
(1) includes coverage for specific health care services or benefits;
(2) places limitations or restrictions on deductibles, coinsurance, copayments, or any annual or lifetime maximum benefit amounts, including limitations provided in Section 1271.151; or
(3) includes a specific category of licensed health care practitioner from whom an enrollee is entitled to receive care.
(b) For purposes of this subchapter, "state-mandated health benefits" does not include coverage that is mandated by federal law or standard provisions or rights required under this code or other laws of this state to be provided in an evidence of coverage that are unrelated to a specific health illness, injury, or condition of an enrollee, including provisions related to:
(1) continuation of coverage under Subchapter G, Chapter 1251;
(2) termination of coverage under Sections 1202.051 and 1501.108;
(3) preexisting conditions under Subchapter D, Chapter 1201, and Sections 1501.102-1501.105;
(4) coverage of children, including newborn or adopted children, under:
(A) Chapter 1504;
(B) Chapter 1503;
(C) Section 1501.157;
(D) Section 1501.158; and
(E) Sections 1501.607-1501.609;
(5) services of providers under Section 843.304;
(6) coverage for serious mental health illness under Subchapter A, Chapter 1355; and
(7) coverage for cancer screenings under:
(A) Chapter 1356;
(B) Chapter 1362;
(C) Chapter 1363; and
(D) Chapter 1370.
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.030(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.030(a), eff. September 1, 2007.
Section: Previous 1507.003 1507.004 1507.005 1507.006 1507.007 1507.008 1507.009 1507.051 1507.052 1507.053 1507.054 1507.055 1507.056 1507.057 1507.058 NextLast modified: September 28, 2016