CHAPTER 1364. COVERAGE PROVISIONS RELATING TO HIV, AIDS, OR HIV-RELATED ILLNESSES - Texas Statutes

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES

CHAPTER 1364. COVERAGE PROVISIONS RELATING TO HIV, AIDS, OR

HIV-RELATED ILLNESSES

SUBCHAPTER A. EXCLUSION FROM OR DENIAL OF COVERAGE PROHIBITED

Sec. 1364.001. APPLICABILITY OF SUBCHAPTER. This subchapter

applies only to a group health benefit plan that is delivered,

issued for delivery, or renewed and that is:

(1) a group accident and health insurance policy;

(2) a group contract issued by a group hospital service

corporation operating under Chapter 842; or

(3) a group evidence of coverage issued by a health maintenance

organization operating under Chapter 843.

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

2005.

Sec. 1364.002. EXCEPTION. This subchapter does not apply to:

(1) a credit accident and health insurance policy subject to

Chapter 1153;

(2) any group specifically provided for or authorized by law in

existence and covered under a policy filed with the State Board

of Insurance before April 1, 1975;

(3) accident or health coverage that is incidental to any form

of a group automobile, casualty, property, workers' compensation,

or employers' liability policy approved by the department; or

(4) any policy or contract of insurance with a state agency,

department, or board providing health services:

(A) to eligible individuals under Chapter 32, Human Resources

Code; or

(B) under a state plan adopted in accordance with 42 U.S.C.

Sections 1396-1396g, as amended, or 42 U.S.C. Section 1397aa et

seq., as amended.

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

2005.

Sec. 1364.003. PROHIBITION. A group health benefit plan may not

exclude or deny coverage for:

(1) human immunodeficiency virus (HIV);

(2) acquired immune deficiency syndrome (AIDS); or

(3) an HIV-related illness.

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

2005.

Sec. 1364.004. RULES. The commissioner may adopt rules

necessary to administer this subchapter. A rule adopted under

this section is subject to notice and hearing as provided by

Section 1201.007 for a rule adopted under Chapter 1201.

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

2005.

SUBCHAPTER B. CANCELLATION OF GROUP COVERAGE PROHIBITED

Sec. 1364.051. DEFINITIONS. In this subchapter, "AIDS" and

"HIV" have the meanings assigned by Section 81.101, Health and

Safety Code.

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

2005.

Sec. 1364.052. APPLICABILITY OF SUBCHAPTER. This subchapter

applies to an insurer that delivers or issues for delivery a

group health insurance policy or contract in this state,

including a group hospital service corporation operating under

Chapter 842.

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

2005.

Sec. 1364.053. PROHIBITION. (a) Except as provided by

Subsection (b), an insurer may not cancel during the term of a

group health insurance policy or contract an individual's

coverage provided by the policy or contract because the

individual:

(1) has been diagnosed as having AIDS or HIV;

(2) has been treated for AIDS or HIV; or

(3) is being treated for AIDS or HIV.

(b) The insurer may cancel the coverage provided by the policy

or contract for fraud or misrepresentation in the obtaining of

coverage by failure to disclose a diagnosis of AIDS or an

HIV-related condition.

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

2005.

SUBCHAPTER C. CERTAIN COVERAGES PROVIDED BY LOCAL GOVERNMENTS

Sec. 1364.101. PROHIBITION ON EXCLUSION OR LIMITATION OF

COVERAGES. A political subdivision that provides group health

insurance coverage, health maintenance organization coverage, or

self-insured health care coverage to the political subdivision's

officers or employees may not contract for or provide coverage

that excludes or limits coverage or services for:

(1) acquired immune deficiency syndrome, as defined by the

Centers for Disease Control and Prevention of the United States

Public Health Service; or

(2) human immunodeficiency virus infection.

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

2005.