CHAPTER 1203. COORDINATION OF BENEFITS PROVISIONS - Texas Statutes

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE A. HEALTH COVERAGE IN GENERAL

CHAPTER 1203. COORDINATION OF BENEFITS PROVISIONS

Sec. 1203.001. APPLICABILITY OF CHAPTER. (a) This chapter

applies only to:

(1) a policy of group accident and health insurance as described

by Chapter 1251;

(2) a policy of blanket accident and health insurance as

described by Chapter 1251;

(3) a policy of individual accident and health insurance as

defined by Section 1201.001; or

(4) an evidence of coverage as defined by Section 843.002.

(b) This chapter does not apply to an individual accident and

health insurance policy that is designed to fully integrate with

other policies through a variable deductible.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1203.002. CERTAIN COORDINATION OF BENEFITS PROVISIONS

PROHIBITED. (a) An accident and health insurance policy or

evidence of coverage may not be delivered, issued for delivery,

or renewed in this state if:

(1) a provision of the policy or evidence of coverage excludes

or reduces the payment of benefits to or on behalf of an insured

or enrollee;

(2) the reason for the exclusion or reduction is that benefits

are also payable or have been paid to or on behalf of the insured

or enrollee under a supplemental policy of accident and health

insurance; and

(3) the supplemental policy is individually underwritten and

individually issued as a plan of coverage for:

(A) hospital confinement indemnity;

(B) a specified disease; or

(C) a limited benefit.

(b) Application of Subsection (a) to a provision of an accident

and health insurance policy or evidence of coverage is not

affected by:

(1) the mode or channel by which the premium for a supplemental

policy of accident and health insurance is paid to the insurer;

or

(2) a reduction in the premium for a supplemental policy of

accident and health insurance because of the insured's membership

in an organization or status as an employee.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.

Sec. 1203.003. CERTAIN COORDINATION OF BENEFITS PROVISIONS VOID.

A provision of an accident and health insurance policy or

evidence of coverage that violates Section 1203.002 is void.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,

2005.