SUBCHAPTER A GENERAL PROVISIONS
- Texas Section 1251.001 - Definitions
In this chapter: (1) "Blanket accident and health insurance" means accident, health, or accident and health insurance covering a group described by Subchapter H. (2)...
- Texas Section 1251.002 - Certain Group Health Insurance Authorized
A group policy of accident, health, or accident and health insurance, including a group contract issued by a group hospital service corporation, may be delivered...
- Texas Section 1251.003 - Certain Blanket Health Insurance Authorized
A blanket policy of accident, health, or accident and health insurance may be delivered or issued for delivery in this state only if the policy:...
- Texas Section 1251.004 - Certain Payments By Insurers Prohibited
(a) Except as reimbursement for the cost of services that otherwise would have been provided by the insurer, an insurer may not pay to any...
- Texas Section 1251.005 - Payment Of Benefits
(a) Except as otherwise provided by this section or Section 1251.113, benefits under a group accident and health insurance policy or blanket accident and health...
- Texas Section 1251.006 - Policy May Not Specify Service Provider
A group accident and health insurance policy or blanket accident and health insurance policy may not require that a covered service be provided by a...
- Texas Section 1251.007 - Exceptions
This subchapter and Subchapters B-I do not apply to: (1) a credit accident and health insurance policy subject to Chapter 1153; (2) any group specifically...
SUBCHAPTER B GROUP ACCIDENT AND HEALTH INSURANCE: ELIGIBLE POLICYHOLDERS
- Texas Section 1251.008 - Rules
The commissioner may adopt rules necessary to administer this chapter. A rule adopted under this section is subject to notice and hearing as provided by...
- Texas Section 1251.051 - Employers
(a) For purposes of this section, "employee" includes: (1) an officer, manager, or employee of the employer; (2) an individual proprietor or partner, if the...
- Texas Section 1251.052 - Associations
(a) A group accident and health insurance policy may be issued to an association, including a labor union or an organization of labor unions, a...
- Texas Section 1251.053 - Funds Established By Employers, Labor Unions, Or Associations
(a) A group accident and health insurance policy may be issued to the trustees of a fund established by two or more employers in the...
- Texas Section 1251.054 - Eligibility For Group Life Insurance
A group accident and health insurance policy may be issued to any individual or organization to which a policy of group life insurance may be...
- Texas Section 1251.055 - Fund For Former Employees And Members
(a) An insurer may issue a group accident and health insurance policy to a trustee of a fund to insure former employees, former members, and...
SUBCHAPTER C GROUP ACCIDENT AND HEALTH INSURANCE: REQUIRED PROVISIONS
- Texas Section 1251.056 - Other Groups
(a) Under the requirements prescribed by this section, a group accident and health insurance policy may be issued to cover a group other than a...
- Texas Section 1251.101 - Required Provisions
(a) A group accident and health insurance policy, including a group contract issued by a group hospital service corporation, may not be delivered in this...
- Texas Section 1251.102 - Payment Of Premiums
A group accident and health insurance policy must provide that premiums due under the policy must be remitted by the premium payor as designated in...
- Texas Section 1251.103 - Incontestability Of Policy
(a) A group accident and health insurance policy must provide that: (1) the validity of the policy may not be contested after the policy has...
- Texas Section 1251.104 - Entire Contract
A group accident and health insurance policy must provide that the policy and any application attached to the policy constitute the entire contract between the...
- Texas Section 1251.105 - Statement Made By Policyholder Or Insured
A group accident and health insurance policy must provide that: (1) in the absence of fraud, a statement made by the policyholder or an insured...
- Texas Section 1251.106 - Distinction Based On Marital Status Prohibited
A group accident and health insurance policy must include a provision that prohibits a distinction on the basis of the marital status or lack of...
- Texas Section 1251.107 - Evidence Of Insurability
A group accident and health insurance policy must state the conditions, if any, under which the insurer reserves the right to require an individual eligible...
- Texas Section 1251.108 - Exclusion Or Limitation Of Coverage For Preexisting Conditions
(a) A group accident and health insurance policy must specify the additional exclusions or limitations, if any, applicable under the policy with respect to a...
- Texas Section 1251.109 - Adjustment Of Premiums Or Benefits If Age Of Insured Is Misstated
(a) A group accident and health insurance policy under which the premiums or benefits vary by age must specify an equitable adjustment of premiums or...
- Texas Section 1251.110 - Deadline For Notice Of Claim
(a) A group accident and health insurance policy must provide that written notice of a claim must be given to the insurer not later than...
- Texas Section 1251.111 - Claim Forms
(a) A group accident and health insurance policy must provide that the insurer will furnish to the person making a claim or to the policyholder...
- Texas Section 1251.112 - Deadline For Claim
(a) A group accident and health insurance policy must provide that: (1) in the case of a claim for a loss other than a claim...
- Texas Section 1251.113 - Prompt Payment Of Benefits Required
A group accident and health insurance policy must provide that: (1) all benefits payable under the policy, other than benefits for loss of time, must...
- Texas Section 1251.114 - Payment Of Benefits
(a) A group accident and health insurance policy must provide that all benefits of the policy, other than benefits for loss of life, must be...
- Texas Section 1251.115 - Right To Conduct Physical Examination Or Autopsy
A group accident and health insurance policy must provide that the insurer has the right and opportunity to: (1) conduct a physical examination of an...
- Texas Section 1251.116 - Legal Or Equitable Actions; Limitations
A group accident and health insurance policy must provide that an action at law or in equity may not be brought to recover on the...
SUBCHAPTER D GROUP ACCIDENT AND HEALTH INSURANCE: COVERAGE FOR DEPENDENTS
- Texas Section 1251.117 - Continuation Or Conversion Of Coverage
(a) A group accident and health insurance policy must describe the continuation of group coverage and any conversion coverage provided in accordance with Subchapter F....
- Texas Section 1251.151 - Coverage For Certain Grandchildren
(a) A group policy or contract of insurance for hospital, surgical, or medical expenses incurred as a result of accident or sickness, including a group...
- Texas Section 1251.152 - Optional Coverage For Spouses And Dependents
(a) For purposes of this section, "dependent" includes: (1) a child of an employee or member who is: (A) unmarried; and (B) younger than 25...
- Texas Section 1251.153 - Optional Continuation Of Dependents' Benefits On Death Of Insured
(a) A group accident and health insurance policy that provides for the payment by the insurer of benefits for members of the family or dependents...
SUBCHAPTER E GROUP ACCIDENT AND HEALTH INSURANCE: GENERAL PROVISIONS
- Texas Section 1251.154 - Coverage For Adopted Children
A group policy or contract of insurance for hospital, surgical, or medical expenses incurred as a result of accident or sickness, including a group contract...
- Texas Section 1251.201 - Certificate Of Insurance; Notice Of Separate Available Coverage
(a) An insurer issuing a group policy under this chapter shall provide to the policyholder for delivery to each employee or member of the insured...
SUBCHAPTER F CONTINUATION OR CONVERSION PRIVILEGE ON TERMINATION OF COVERAGE UNDER GROUP POLICY
- Texas Section 1251.202 - Notice Regarding Certain Employer Health Benefit Plans
(a) In this section, "standard health benefit plan" means a plan offered under Chapter 1507. (b) If an employer offers to employees a standard health...
- Texas Section 1251.251 - Continuation Of Group Coverage Required; Exception
(a) An insurer or group hospital service corporation that issues policies that provide hospital, surgical, or major medical expense insurance coverage or any combination of...
- Texas Section 1251.252 - Eligibility For Continuation Of Group Coverage
(a) An employee, member, or dependent is entitled to continuation of group coverage if: (1) the individual's coverage under the group policy is terminated for...
- Texas Section 1251.253 - Request For Continuation Of Group Coverage
An employee, member, or dependent must provide to the employer or group policyholder a written request for continuation of group coverage not later than the...
- Texas Section 1251.254 - Payment Of Contributions
Except as provided by this section, an employee, member, or dependent who elects to continue group coverage under this subchapter must pay to the employer...
- Texas Section 1251.255 - Termination Of Continued Coverage
(a) Group coverage continued under this subchapter may not terminate until the earliest of: (1) the date the maximum continuation period provided by law would...
- Texas Section 1251.256 - Conversion Of Group Policy
(a) An insurer may offer a conversion policy to each employee, member, or dependent who is covered under a group accident and health insurance policy...
- Texas Section 1251.257 - Premium For Converted Policy
(a) An insurer shall determine the premium for a converted policy issued under this subchapter in accordance with the insurer's table of premium rates for...
- Texas Section 1251.258 - Benefits Under Converted Policy
The commissioner by rule shall establish minimum standards for benefits under converted policies issued under this subchapter. Added by Acts 2003, 78th Leg., ch. 1274,...
- Texas Section 1251.259 - Termination Of Converted Policy
Conversion coverage under this subchapter for an insured may not terminate until the earlier of: (1) the date failure to make timely payments would terminate...
SUBCHAPTER G CONTINUATION OF GROUP COVERAGE FOR CERTAIN FAMILY MEMBERS AND DEPENDENTS
- Texas Section 1251.260 - Notice Of Continuation And Conversion Privileges
(a) An employer that provides to its employees group accident and health insurance coverage that includes a group continuation or conversion privilege on termination of...
- Texas Section 1251.301 - Continuation Of Group Coverage
A group policy or contract delivered, issued for delivery, renewed, amended, or extended in this state, including a group contract issued by a group hospital...
- Texas Section 1251.302 - Eligibility For Continued Coverage
A family member or dependent of an insured is eligible for continued coverage under this subchapter if the family member or dependent: (1) has been...
- Texas Section 1251.303 - Physical Examination Not Required
An individual who exercises the option to continue group coverage under this subchapter may not be required to take and pass a physical examination as...
- Texas Section 1251.304 - Scope Of Coverage
(a) An individual covered under group continuation coverage under this subchapter is entitled to coverage that is identical in scope to the coverage provided under...
- Texas Section 1251.305 - Amount Of Premium
Except as provided by Section 1551.064, the premium for continuation of a spouse or dependent on the group health insurance policy or contract may not...
- Texas Section 1251.306 - Payment Of Premiums
(a) An individual covered under group continuation coverage under this subchapter shall pay premiums for the coverage directly to the group policyholder or contract holder....
- Texas Section 1251.307 - Notice Of Continuation Option
Except as provided by Section 1551.064, at the time a health insurance policy or contract is issued, the group policyholder or contract holder shall give...
- Texas Section 1251.308 - Notice Of Severance Of Family Relationship; Notice Of Desire To Exercise Option
(a) Except as provided by Section 1551.064, each group health insurance policy or contract must require a group member to give written notice to the...
- Texas Section 1251.309 - Continuation Of Certain Coverages
(a) Any period of previous coverage under the health insurance policy or contract, including a policy or contract executed under Chapter 1551, must be used...
SUBCHAPTER H BLANKET ACCIDENT AND HEALTH INSURANCE: ELIGIBLE POLICYHOLDERS
- Texas Section 1251.310 - Termination Of Continued Coverage
The coverage of an individual who exercises the continuation option under this subchapter continues without interruption and may not be canceled or otherwise terminated until:...
- Texas Section 1251.351 - Common Carrier Or Motor Vehicle Rental Or Leasing Company
(a) A blanket accident and health insurance policy may be issued to: (1) a common carrier or the operator, owner, or lessor of a means...
- Texas Section 1251.352 - Employers
(a) A blanket accident and health insurance policy may be issued to an employer to cover any group of employees, dependents, or guests defined by...
- Texas Section 1251.353 - Educational Institutions
(a) A blanket accident and health insurance policy may be issued to a college, school, or other institution of learning, to a school district or...
- Texas Section 1251.354 - Religious, Charitable, Recreational, Educational, Or Civic Organization
(a) A blanket accident and health insurance policy may be issued to a religious, charitable, recreational, educational, or civic organization, or a branch of the...
- Texas Section 1251.355 - Sports Team Or Camp
(a) A blanket accident and health insurance policy may be issued to a sports team or camp or the sponsor of a sports team or...
- Texas Section 1251.356 - Governmental Or Volunteer Emergency Services Organization
(a) A blanket accident and health insurance policy may be issued to a governmental or volunteer fire department or fire company, first aid or civil...
- Texas Section 1251.357 - Newspaper Or Other Publisher
(a) A blanket accident and health insurance policy may be issued to a newspaper or other publisher to cover the publisher's carriers. (b) The publisher...
- Texas Section 1251.358 - Association
(a) A blanket accident and health insurance policy may be issued to an association, including a labor union, to cover any group of members or...
SUBCHAPTER I BLANKET ACCIDENT AND HEALTH INSURANCE: GENERAL PROVISIONS
- Texas Section 1251.359 - Coverage For Other Risks
(a) A blanket accident and health insurance policy may be issued to cover any risk or class of risks other than a risk described by...
- Texas Section 1251.401 - Individual Application And Certificate Not Required
(a) An individual application from an insured under a blanket accident and health insurance policy is not required. (b) An insurer is not required to...
SUBCHAPTER J REGULATION OF OUT-OF-STATE GROUP ACCIDENT AND HEALTH INSURANCE COVERAGE
- Texas Section 1251.402 - Liability Of Policyholder Not Affected
Subchapter H and this subchapter do not affect the legal liability of a policyholder for the death of or injury to a member of a...
- Texas Section 1251.451 - Applicability Of Certain Laws To Out-of-state Group Accident And Health Insurance Coverage
(a) Chapters 1365 and 1368 and Subchapters A and C, Chapter 1451, apply to: (1) a certificate of insurance issued to a resident of this...