CHAPTER 1359. FORMULAS FOR INDIVIDUALS WITH PHENYLKETONURIA OR OTHER HERITABLE DISEASES - Texas Statutes

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES

CHAPTER 1359. FORMULAS FOR INDIVIDUALS WITH PHENYLKETONURIA OR

OTHER HERITABLE DISEASES

Sec. 1359.001. DEFINITIONS. In this chapter:

(1) "Heritable disease" means an inherited disease that may

result in mental or physical retardation or death.

(2) "Phenylketonuria" means an inherited condition that, if not

treated, may cause severe mental retardation.

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

2005.

Sec. 1359.002. APPLICABILITY OF CHAPTER. This chapter applies

only to a group health benefit plan that is a group policy,

contract, or certificate of health insurance or an evidence of

coverage delivered, issued for delivery, or renewed in this state

by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter

842; or

(3) a health maintenance organization operating under Chapter

843.

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

2005.

Sec. 1359.003. COVERAGE REQUIRED. (a) A group health benefit

plan must provide coverage for formulas necessary to treat

phenylketonuria or a heritable disease.

(b) The group health benefit plan must provide the coverage to

the same extent that the plan provides coverage for drugs that

are available only on the orders of a physician.

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

2005.