Texas Insurance Code Title 8, Chapter 1355 - Benefits For Certain Mental Disorders
SUBCHAPTER A GROUP HEALTH BENEFIT PLAN COVERAGE
- Texas Section 1355.001 - Definitions
In this subchapter: (1) "Serious mental illness" means the following psychiatric illnesses as defined by the American Psychiatric Association in the Diagnostic and Statistical Manual...
- Texas Section 1355.002 - Applicability Of Subchapter
(a) This subchapter applies only to a group health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a...
- Texas Section 1355.003 - Exception
(a) This subchapter does not apply to coverage under: (1) a blanket accident and health insurance policy, as described by Chapter 1251; (2) a short-term...
- Texas Section 1355.004 - Required Coverage For Serious Mental Illness
(a) A group health benefit plan: (1) must provide coverage, based on medical necessity, for not less than the following treatments of serious mental illness...
- Texas Section 1355.005 - Managed Care Plan Authorized
A group health benefit plan issuer may provide or offer coverage required by Section 1355.004 through a managed care plan. Added by Acts 2003, 78th...
- Texas Section 1355.006 - Coverage For Certain Conditions Related To Controlled Substance Or Marihuana Not Required
(a) In this section, "controlled substance" and "marihuana" have the meanings assigned by Section 481.002, Health and Safety Code. (b) This subchapter does not require...
- Texas Section 1355.007 - Small Employer Coverage
An issuer of a group health benefit plan to a small employer must offer the coverage described by Section 1355.004 to the employer but is...
SUBCHAPTER B ALTERNATIVE MENTAL HEALTH TREATMENT BENEFITS
- Texas Section 1355.015 - Required Coverage For Certain Enrollees
(a) At a minimum, a health benefit plan must provide coverage for screening a child for autism spectrum disorder at the ages of 18 and...
- Texas Section 1355.051 - Definitions
In this subchapter: (1) "Crisis stabilization unit" means a 24-hour residential program that provides, usually for a short term, intensive supervision and highly structured activities...
- Texas Section 1355.052 - Applicability Of Subchapter
This subchapter applies to a group health benefit plan that is delivered or issued for delivery in this state and that is: (1) an accident...
- Texas Section 1355.053 - Required Coverage For Certain Illnesses And Disorders
A group health benefit plan that provides coverage for treatment of mental or emotional illness or disorder for a covered individual when the individual is...
- Texas Section 1355.054 - Conditions For Coverage
(a) Benefits of coverage provided under this subchapter may be used only in a situation in which: (1) the covered individual has a serious mental...
- Texas Section 1355.055 - Determinations For Treatment In A Residential Treatment Center For Children And Adolescents
(a) Treatment in a residential treatment center for children and adolescents must be determined as if necessary care and treatment were inpatient care and treatment...
- Texas Section 1355.056 - Determinations For Treatment By A Crisis Stabilization Unit
(a) Treatment by a crisis stabilization unit must be determined as if necessary care and treatment were inpatient care and treatment in a hospital. (b)...
- Texas Section 1355.057 - Review And Adjustment Of Minimum Ratios Of Reimbursement
(a) The commissioner shall monitor and review the minimum ratios of reimbursement for alternative treatments required by Sections 1355.055 and 1355.056. (b) If the commissioner...
SUBCHAPTER C PSYCHIATRIC DAY TREATMENT FACILITIES
- Texas Section 1355.058 - Assistance Of The Texas Department Of Mental Health And Mental Retardation
(a) The Texas Department of Mental Health and Mental Retardation shall assist the department in carrying out the department's responsibilities under this subchapter. (b) The...
- Texas Section 1355.101 - Definition
In this subchapter, "psychiatric day treatment facility" means a mental health facility that: (1) provides treatment for individuals suffering from acute mental and nervous disorders...
- Texas Section 1355.102 - Applicability Of Subchapter
This subchapter applies to a group policy of accident and health insurance delivered or issued for delivery in this state, including a group policy issued...
- Texas Section 1355.103 - 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...
- Texas Section 1355.104 - Required Coverage For Treatment In Psychiatric Day Treatment Facility
(a) A group insurance policy that provides coverage for treatment of mental or emotional illness or disorder when an individual is confined in a hospital...
- Texas Section 1355.105 - Determinations For Treatment In Psychiatric Day Treatment Facility
(a) Benefits provided under this subchapter shall be determined as if necessary care and treatment in a psychiatric day treatment facility were inpatient care and...
SUBCHAPTER D CERTAIN COVERAGES PROVIDED BY LOCAL GOVERNMENTS
- Texas Section 1355.106 - Offer Of Coverage Required; Alternative Benefits
(a) An insurer shall offer, and a policyholder is entitled to reject, coverage under a group insurance policy for treatment of mental or emotional illness...
SUBCHAPTER E BENEFITS FOR TREATMENT BY TAX-SUPPORTED INSTITUTION
- Texas Section 1355.151 - Prohibition On Exclusion Or Limitation Of Certain Coverages
(a) In this section, "serious mental illness" has the meaning assigned by Section 1355.001. (b) A political subdivision that provides group health insurance coverage, health...
- Texas Section 1355.201 - 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...
- Texas Section 1355.202 - Prohibition Of Exclusion Of Mental Health Or Mental Retardation Benefits For Treatment By Tax-supported Institution
(a) An individual or group accident and health insurance policy delivered or issued for delivery to a person in this state that provides coverage for...
Last modified: September 28, 2016