SUBCHAPTER A GENERAL PROVISIONS
SUBCHAPTER B DESIGNATION OF PRACTITIONERS UNDER ACCIDENT AND HEALTH INSURANCE POLICY
- Texas Section 1451.001 - Definitions; Health Care Practitioners
In this chapter: (1) "Acupuncturist" means an individual licensed to practice acupuncture by the Texas State Board of Medical Examiners. (2) "Advanced practice nurse" means...
- Texas Section 1451.051 - Applicability Of Subchapter
(a) This subchapter applies to an accident and health insurance policy, including an individual, blanket, or group policy. (b) This subchapter applies to an accident...
- Texas Section 1451.052 - Applicability Of General Provisions Of Other Law
The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, the construction of policies under that chapter, rulemaking...
- Texas Section 1451.053 - Practitioner Designation
(a) An accident and health insurance policy may not make a benefit contingent on treatment or examination by one or more particular health care practitioners...
SUBCHAPTER C SELECTION OF PRACTITIONERS
- Texas Section 1451.054 - Terms Used To Designate Health Care Practitioners
A provision of an accident and health insurance policy that designates the health care practitioners whom the insurer will and will not recognize must use...
- Texas Section 1451.101 - Definitions
In this subchapter: (1) "Health insurance policy" means a policy, contract, or agreement described by Section 1451.102. (2) "Insured" means an individual who is issued,...
- Texas Section 1451.102 - Applicability Of Subchapter
Except as provided by this subchapter, this subchapter applies only to an individual, group, blanket, or franchise insurance policy, insurance agreement, or group hospital service...
- Texas Section 1451.103 - Conflicting Provisions Void
(a) A provision of a health insurance policy that conflicts with this subchapter is void to the extent of the conflict. (b) The presence in...
- Texas Section 1451.104 - Nondiscriminatory Payment Or Reimbursement; Exception
(a) An insurer may not classify, differentiate, or discriminate between scheduled services or procedures provided by a health care practitioner selected under this subchapter and...
- Texas Section 1451.105 - Selection Of Acupuncturist
An insured may select an acupuncturist to provide the services or procedures scheduled in the health insurance policy that are within the scope of the...
- Texas Section 1451.106 - Selection Of Advanced Practice Nurse
An insured may select an advanced practice nurse to provide the services scheduled in the health insurance policy that are within the scope of the...
- Texas Section 1451.107 - Selection Of Audiologist
An insured may select an audiologist to measure hearing to determine the presence or extent of the insured's hearing loss or provide aural rehabilitation services...
- Texas Section 1451.108 - Selection Of Chemical Dependency Counselor
An insured may select a chemical dependency counselor to provide services or procedures scheduled in the health insurance policy that are within the scope of...
- Texas Section 1451.109 - Selection Of Chiropractor
(a) An insured may select a chiropractor to provide the medical or surgical services or procedures scheduled in the health insurance policy that are within...
- Texas Section 1451.110 - Selection Of Dentist
An insured may select a dentist to provide the medical or surgical services or procedures scheduled in the health insurance policy that are within the...
- Texas Section 1451.111 - Selection Of Dietitian
An insured may select a licensed dietitian or a provisionally licensed dietitian acting under the supervision of a licensed dietitian to provide the services scheduled...
- Texas Section 1451.112 - Selection Of Hearing Instrument Fitter And Dispenser
An insured may select a hearing instrument fitter and dispenser to provide the services or procedures scheduled in the health insurance policy that are within...
- Texas Section 1451.113 - Selection Of Licensed Clinical Social Worker
An insured may select a licensed clinical social worker to provide the services or procedures scheduled in the health insurance policy that: (1) are within...
- Texas Section 1451.114 - Selection Of Licensed Professional Counselor
An insured may select a licensed professional counselor to provide the services scheduled in the health insurance policy that are within the scope of the...
- Texas Section 1451.115 - Selection Of Surgical Assistant
An insured may select a surgical assistant to provide the services or procedures scheduled in the health insurance policy that are within the scope of...
- Texas Section 1451.116 - Selection Of Marriage And Family Therapist
An insured may select a marriage and family therapist to provide the services scheduled in the health insurance policy that are within the scope of...
- Texas Section 1451.117 - Selection Of Nurse First Assistant
An insured may select a nurse first assistant to provide the services scheduled in the health insurance policy that: (1) are within the scope of...
- Texas Section 1451.118 - Selection Of Occupational Therapist
An insured may select an occupational therapist to provide the services scheduled in the health insurance policy that are within the scope of the therapist's...
- Texas Section 1451.119 - Selection Of Optometrist
An insured may select an optometrist to provide the services or procedures scheduled in the health insurance policy that are within the scope of the...
- Texas Section 1451.120 - Selection Of Physical Therapist
An insured may select a physical therapist to provide the services scheduled in the health insurance policy that are within the scope of the therapist's...
- Texas Section 1451.121 - Selection Of Physician Assistant
An insured may select a physician assistant to provide the services scheduled in the health insurance policy that are within the scope of the assistant's...
- Texas Section 1451.122 - Selection Of Podiatrist
An insured may select a podiatrist to provide the medical or surgical services or procedures scheduled in the health insurance policy that are within the...
- Texas Section 1451.123 - Selection Of Psychological Associate
An insured may select a psychological associate to provide the services scheduled in the health insurance policy that are within the scope of the associate's...
- Texas Section 1451.124 - Selection Of Psychologist
An insured may select a psychologist to provide the services or procedures scheduled in the health insurance policy that are within the scope of the...
- Texas Section 1451.125 - Selection Of Speech-language Pathologist
An insured may select a speech-language pathologist to evaluate speech or language, provide habilitative or rehabilitative services to restore speech or language loss, or correct...
- Texas Section 1451.126 - Reimbursement For Physical Modalities And Procedures By Health Insurer, Administrator, Health Maintenance Organization, Or Preferred Provider Benefit Plan Issuer
(a) A health insurer or licensed third-party administrator may not deny reimbursement to a health care practitioner for the provision of covered services of physical...
SUBCHAPTER D ACCESS TO OPTOMETRISTS AND OPHTHALMOLOGISTS USED UNDER MANAGED CARE PLAN
- Texas Section 1451.127 - Duty Of Person Arranging Provider Contracts For Health Insurer Or Health Maintenance Organization
(a) A person who arranges contracts with providers on behalf of a health maintenance organization or health insurer shall comply with laws related to the...
- Texas Section 1451.151 - Definitions
In this subchapter: (1) "Managed care plan" means a plan under which a health maintenance organization, preferred provider benefit plan issuer, or other organization provides...
- Texas Section 1451.152 - Applicability And Construction Of Subchapter
(a) This subchapter applies only to a managed care plan that provides or arranges for benefits for vision or medical eye care services or procedures...
- Texas Section 1451.153 - Use Of Optometrist, Therapeutic Optometrist, Or Ophthalmologist
(a) A managed care plan may not: (1) discriminate against a health care practitioner because the practitioner is an optometrist, therapeutic optometrist, or ophthalmologist; (2)...
- Texas Section 1451.154 - Participation Of Therapeutic Optometrist
(a) In this section: (1) "Medical panel" means the health care practitioners who are listed as participating providers in a managed care plan or who...
- Texas Section 1451.155 - Contracts With Optometrists Or Therapeutic Optometrists
(a) In this section: (1) "Covered product or service" means a vision care product or service for which reimbursement is available under an enrollee's managed...
SUBCHAPTER E DENTAL CARE BENEFITS IN HEALTH INSURANCE POLICIES OR EMPLOYEE BENEFIT PLANS
- Texas Section 1451.156 - Prohibited Conduct
(a) A managed care plan, as described by Section 1451.152(a), may not directly or indirectly: (1) control or attempt to control the professional judgment, manner...
- Texas Section 1451.201 - Definitions
In this subchapter: (1) "Dental care service" means a service provided to a person to prevent, alleviate, cure, or heal a human dental illness or...
- Texas Section 1451.202 - Applicability And Construction Of Subchapter
(a) This subchapter applies only to an employee benefit plan or health insurance policy delivered, issued for delivery, renewed, or contracted for in this state...
- Texas Section 1451.203 - Conflicting Provisions
A provision of an employee benefit plan or health insurance policy that conflicts with this subchapter is void to the extent of the conflict. Added...
- Texas Section 1451.204 - Certain Conduct Permitted
(a) Notwithstanding any other provision of this subchapter, a dentist may contract directly with a patient to provide dental care services to the patient as...
- Texas Section 1451.205 - Disclosure Of Benefit Terms
An employee benefit plan or health insurance policy shall: (1) if applicable, disclose that the benefit for dental care services offered is limited to the...
- Texas Section 1451.206 - Payment Or Reimbursement Of Dentist
(a) The employee benefit plan or health insurance policy shall provide: (1) that payment or reimbursement for a noncontracting provider dentist shall be the same...
- Texas Section 1451.2065 - Contracts With Dentists
(a) In this section, "covered service" means a dental care service for which reimbursement is available under a patient's employee benefit plan or health insurance...
SUBCHAPTER F ACCESS TO OBSTETRICAL OR GYNECOLOGICAL CARE
- Texas Section 1451.207 - Prohibited Conduct
(a) An employee benefit plan or health insurance policy may not: (1) interfere with or prevent an individual who is a party to or beneficiary...
- Texas Section 1451.251 - Definition
In this subchapter, "enrollee" means an individual enrolled in a health benefit plan. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April...
- Texas Section 1451.252 - Applicability Of Subchapter
This subchapter applies only to a health benefit plan that requires an enrollee to obtain certain specialty health care services through a referral made by...
- Texas Section 1451.253 - Exception
This subchapter does not apply to: (1) a plan that provides coverage: (A) only for a specified disease; (B) only for accidental death or dismemberment;...
- Texas Section 1451.254 - Rules
The commissioner shall adopt rules necessary to implement this subchapter. Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
- Texas Section 1451.255 - Right Of Female Enrollee To Select Obstetrician Or Gynecologist
(a) Except as provided by Subsection (b), a health benefit plan shall permit a female enrollee to select, in addition to a primary care physician,...
- Texas Section 1451.256 - Direct Access To Services Of Obstetrician Or Gynecologist
(a) In this section, "health care services" includes: (1) one well-woman examination each year; (2) care related to pregnancy; (3) care for any active gynecological...
- Texas Section 1451.257 - Availability Of Providers
To ensure access to services that are within the scope of the professional specialty practice of a properly credentialed obstetrician or gynecologist, a health benefit...
- Texas Section 1451.258 - Notice Of Available Providers
(a) A health benefit plan issuer shall provide to each person covered under the plan a timely written notice of the choices of the types...
- Texas Section 1451.259 - Limits On Physician Sanctions
(a) A health benefit plan may not sanction or terminate a primary care physician because of female enrollees' access to participating obstetricians and gynecologists under...
SUBCHAPTER G ACCESS TO DIETITIAN SERVICES
- Texas Section 1451.260 - Administrative Penalty
An entity that operates a health benefit plan in violation of this subchapter is subject to an administrative penalty as provided by Chapter 84. Added...
- Texas Section 1451.301 - Applicability Of General Provisions Of Other Law
The provisions of Chapter 1201, including provisions relating to the applicability, purpose, and enforcement of that chapter, the construction of policies under that chapter, rulemaking...
SUBCHAPTER H DISABILITY CERTIFIED BY PODIATRIST
- Texas Section 1451.302 - Dietitian Services
An individual or group accident and health insurance policy delivered or issued for delivery in this state may not: (1) exclude or deny coverage for...
SUBCHAPTER I USE OF OSTEOPATHIC HOSPITAL
- Texas Section 1451.351 - Loss Of Income Benefits For Disability Treatable By Podiatrist
(a) This section applies only to an insurance policy delivered, issued for delivery, or renewed in this state that provides benefits covering loss of income...
- Texas Section 1451.401 - Contract With Osteopathic Hospital
A health maintenance organization or preferred provider benefit plan issuer that contracts with a hospital to provide services to covered individuals may not refuse to...
- Texas Section 1451.402 - Services At Osteopathic Hospital
A health maintenance organization or preferred provider benefit plan issuer that provides benefits for inpatient or outpatient services provided by an allopathic hospital shall seek...
- Texas Section 1451.403 - Request For Action Of Commissioner
An aggrieved party may request that the commissioner conduct an investigation, review, hearing, or other proceeding to determine compliance with this subchapter. Added by Acts...
SUBCHAPTER J REIMBURSEMENT OF HEALTH CARE PROVIDERS
- Texas Section 1451.404 - Enforcement
The commissioner shall take all reasonable actions to ensure compliance with this subchapter, including issuing orders and assessing penalties. Added by Acts 2003, 78th Leg.,...
SUBCHAPTER K HEALTH CARE PROVIDER DIRECTORIES
- Texas Section 1451.451 - Reimbursement Under Medicaid-based Fee Schedule
(a) An insurance company, health maintenance organization, or preferred provider organization that contracts with a health care provider to provide services in connection with Chapter...
- Texas Section 1451.501 - Definitions
In this subchapter: (1) "Health care provider" means a practitioner, institutional provider, or other person or organization that furnishes health care services and that is...
- Texas Section 1451.502 - Applicability Of Subchapter
This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition,...
- Texas Section 1451.503 - Exception
This subchapter does not apply to: (1) a health benefit plan that provides coverage: (A) only for a specified disease or for another single benefit;...
- Texas Section 1451.504 - Physician And Health Care Provider Directories
(a) A health benefit plan issuer that offers coverage for health care services through preferred providers, exclusive providers, or a network of physicians or health...
- Texas Section 1451.505 - Physician And Health Care Provider Directory On Internet Website
(a) A health benefit plan issuer shall display on a public Internet website maintained by the issuer the directory required by Section 1451.504. A direct...