Texas Insurance Code Title 8, Chapter 1652 - Medicare Supplement Benefit Plans
SUBCHAPTER A GENERAL PROVISIONS
- Texas Section 1652.001 - Definitions
In this chapter: (1) "Applicant" means: (A) an individual who seeks to contract for insurance or other health benefits under an individual Medicare supplement benefit...
- Texas Section 1652.002 - Medicare Supplement Benefit Plan
(a) "Medicare supplement benefit plan" means a group or individual policy of accident and health insurance, a subscriber contract of a group hospital service corporation...
- Texas Section 1652.003 - Applicability Of Chapter
This chapter applies to an individual or group Medicare supplement benefit plan delivered or issued for delivery in this state and, regardless of the place...
- Texas Section 1652.004 - Construction Of Chapter
(a) This chapter may not be construed to enlarge the powers of an entity described by Section 1652.003. (b) This chapter controls to the extent...
SUBCHAPTER B BENEFITS
- Texas Section 1652.005 - Rules Necessary For Certification
In addition to other rules required or authorized by this chapter, the commissioner shall adopt reasonable rules necessary and proper to carry out this chapter,...
- Texas Section 1652.051 - Minimum Standards
(a) The commissioner shall adopt reasonable rules to establish specific standards for provisions in Medicare supplement benefit plans and standards for facilitating comparisons of different...
- Texas Section 1652.052 - Minimum Standards For Benefits And Claim Payments
(a) The commissioner shall adopt reasonable rules to establish minimum standards for benefits and claim payments under Medicare supplement benefit plans. (b) The standards for...
- Texas Section 1652.053 - Duplicate Benefits Prohibited
A Medicare supplement benefit plan or certificate in force in this state may not contain benefits that duplicate benefits provided by Medicare. Added by Acts...
- Texas Section 1652.054 - Basic Plan
An entity described by Section 1652.003 that offers for sale in this state a Medicare supplement benefit plan must offer a basic Medicare supplement benefit...
- Texas Section 1652.055 - Additional Benefits
(a) In addition to the basic Medicare supplement benefit plan described by Section 1652.054, an entity may offer additional Medicare supplement benefit plans for sale...
- Texas Section 1652.056 - Coverage For Mammography
(a) In this section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including the x-ray tube, filter, compression...
- Texas Section 1652.057 - Waiver Of Waiting Period
(a) An entity that delivers or issues for delivery in this state a Medicare supplement benefit plan or certificate that replaces a Medicare supplement benefit...
SUBCHAPTER C LOSS RATIO STANDARDS
- Texas Section 1652.058 - Coverage For Preexisting Condition
(a) A Medicare supplement benefit plan may not contain a provision that excludes coverage for a claim for losses incurred more than six months after...
- Texas Section 1652.101 - Loss Ratio Standards
(a) A Medicare supplement benefit plan must return to a plan holder benefits that are reasonable in relation to the premium charged. (b) The commissioner...
- Texas Section 1652.102 - Filing Requirements
(a) Annually, each entity providing Medicare supplement benefit plans in this state shall file with the department the entity's rates, rating schedule, and supporting documentation...
- Texas Section 1652.103 - Review Of Premium Increases
(a) The commissioner by rule shall provide a process for reviewing and approving or disapproving a proposed premium increase relating to a Medicare supplement benefit...
- Texas Section 1652.104 - Benefit Changes
(a) Before the date on which a Medicare benefit change required by federal law takes effect, each entity providing in this state a Medicare supplement...
SUBCHAPTER D CONSUMER INFORMATION AND NOTICE
- Texas Section 1652.105 - Reporting Loss Ratio Information To Secretary Of Health And Human Services
To the extent necessary for this state to obtain or retain certification as a state with an approved regulatory program, the department shall comply with...
- Texas Section 1652.151 - Rules Relating To Disclosure
The rules adopted under Sections 1652.152, 1652.153, and 1652.154 must include provisions and requirements that are at least equal to those required by federal law,...
- Texas Section 1652.152 - Outline Of Coverage
(a) To provide for full and fair disclosure in the sale of Medicare supplement benefit plans, a Medicare supplement benefit plan or certificate may not...
- Texas Section 1652.153 - Informational Brochure
(a) The commissioner by rule may prescribe a standard form and the contents of an informational brochure intended to improve the ability of an individual...
- Texas Section 1652.154 - Notice Relating To Other Types Of Coverage
(a) The commissioner may adopt reasonable rules for captions or notice requirements for each accident and health insurance policy, subscriber contract, or evidence of coverage...
- Texas Section 1652.155 - Right To Return For Refund; Notice
(a) If an applicant is not satisfied for any reason after examining a Medicare supplement benefit plan document or certificate, the applicant is entitled to...
SUBCHAPTER E AGENTS
- Texas Section 1652.156 - Advertising Filing Requirements
(a) The commissioner shall adopt reasonable rules to require each entity described by Section 1652.003 to file with the department a copy of any advertisement...
- Texas Section 1652.201 - Information Provided To Agents
(a) An entity that offers a Medicare supplement benefit plan for sale in this state shall provide to each agent authorized to sell that plan...
SUBCHAPTER F OUTPATIENT PRESCRIPTION DRUGS
- Texas Section 1652.202 - Permitted Compensation Arrangements
(a) The commissioner by rule shall limit the commission or other compensation that may be paid to an agent for the sale of a Medicare...
- Texas Section 1652.251 - Outpatient Prescription Drug Benefit Plans
(a) An entity described by Section 1652.003 that issues a Medicare supplement benefit plan in this state may offer a group or individual policyholder: (1)...
- Texas Section 1652.252 - Prescription Drug Discount Programs
(a) In this section, "prescription drug discount program" means any program that entitles a participant to purchase prescription drugs or other medical supplies and services...
Last modified: September 28, 2016