Tex.
Ins. Code Section 1355.253
Exceptions
(a)
This subchapter does not apply to:(1)
a plan that provides coverage:(A)
for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;(B)
as a supplement to a liability insurance policy;(C)
for credit insurance;(D)
only for dental or vision care;(E)
only for hospital expenses;(F)
only for indemnity for hospital confinement; or(G)
only for accidents;(2)
a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss(g)(1));(3)
a workers’ compensation insurance policy;(4)
medical payment insurance coverage provided under a motor vehicle insurance policy; or(5)
a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1355.252 (Applicability of Subchapter).(b)
To the extent that this section would otherwise require this state to make a payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 C.F.R. Section 155.20, is not required to provide a benefit under this subchapter that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).
Source:
Section 1355.253 — Exceptions, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1355.htm#1355.253 (accessed May 25, 2024).
