Texas Insurance Code Title 8, Chapter 1204 - Procedures For Payment Of Certain Health And Accident Insurance Policy Or Plan Benefits

SUBCHAPTER A PAYMENTS TO CERTAIN PUBLIC HOSPITALS

• Texas Section 1204.001 - Nonapplicability To Certain Facilities
  This subchapter does not apply to indigent care or chronic disease care provided in or by an eleemosynary institution, sanitarium, sanitorium, mental health treatment facility,...

SUBCHAPTER B ASSIGNMENT OF BENEFIT PAYMENTS

• Texas Section 1204.002 - Benefits Payable For Treatment Provided By Hospital Owned By State Or Unit Of Local Government
  An insurance policy providing hospital, nursing, medical, or surgical coverage that is issued or delivered in this state after August 27, 1973, may not include...
• Texas Section 1204.051 - Definitions
  In this subchapter: (1) "Covered person" means a person who is insured or covered by a health insurance policy or is a participant in an...
• Texas Section 1204.052 - Applicability To Certain Plans Or Programs
  This subchapter applies to: (1) an employee benefit plan, to the extent not preempted by the Employee Retirement Income Security Act of 1974 (29 U.S.C....
• Texas Section 1204.053 - Assignment Of Benefits
  (a) An insurer may not deliver, renew, or issue for delivery in this state a health insurance policy that prohibits or restricts a covered person...
• Texas Section 1204.054 - Payment Of Benefits According To Assignment
  An insurer shall pay benefits directly to a physician or other health care provider, and the insurer is relieved of the obligation to pay, and...

SUBCHAPTER C UNIFORM CLAIM BILLING FORMS

• Texas Section 1204.055 - Contractual Responsibility For Deductibles And Copayments
  (a) The payment of benefits under an assignment does not relieve a covered person of a contractual obligation to pay a deductible or copayment. (b)...
• Texas Section 1204.101 - Definitions
  In this subchapter: (1) "Health benefit plan" means a group, blanket, or franchise insurance policy, a group hospital service contract, or a group subscriber contract...

SUBCHAPTER D PAYMENTS FOR CERTAIN PUBLICLY PROVIDED SERVICES

• Texas Section 1204.102 - Required Claim Billing Forms
  A provider who seeks payment or reimbursement under a health benefit plan and the health benefit plan issuer that issued the plan shall use uniform...
• Texas Section 1204.151 - Definition
  In this subchapter, "policy" means an individual or group policy of accident and health insurance, including a policy issued by a group hospital service corporation...
• Texas Section 1204.152 - Payment For Certain Expenses Incurred By Texas Department Of Human Services
  Each policy delivered or issued for delivery in this state must provide for the repayment of the actual costs of medical expenses the Texas Department...
• Texas Section 1204.153 - Payments To Texas Department Of Human Services For Certain Children
  (a) This section applies only to a policy that is delivered, issued for delivery, or renewed in this state and that provides coverage for a...

SUBCHAPTER E EXCLUSIONARY CLAUSES

• Texas Section 1204.154 - Uniform Provisions
  (a) The commissioner shall adopt uniform policy provisions, riders, and endorsements for the policy requirement of Section 1204.153. (b) Before the commissioner adopts or makes...

SUBCHAPTER F PAYMENT OF BENEFITS TO CONSERVATOR OF MINOR

• Texas Section 1204.201 - Prohibition Of Exclusion Of Certain Medical Assistance Benefits
  An individual or group accident and health insurance policy delivered or issued for delivery in this state, including a policy issued by a group hospital...
• Texas Section 1204.251 - Payment To Conservator Other Than Group Member
  (a) An insurer or group hospital service corporation operating under Chapter 842 that delivers, issues for delivery, or renews in this state a group accident...
• Texas Section 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...
• Texas Section 1204.253 - Rules
  The commissioner may adopt rules to ensure the effective implementation of this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April...

Last modified: September 28, 2016