State Codes and Statutes
Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1503-coverage-of-certain-students
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE G. HEALTH COVERAGE AVAILABILITY
CHAPTER 1503. COVERAGE OF CERTAIN STUDENTS
Sec. 1503.001. APPLICABILITY OF CHAPTER. This chapter applies
only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses incurred
as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise insurance policy
or insurance agreement, a group hospital service contract, or an
individual or group evidence of coverage that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation operating under
Chapter 842;
(iii) a fraternal benefit society operating under Chapter 885;
(iv) a stipulated premium company operating under Chapter 884;
or
(v) a health maintenance organization operating under Chapter
843; and
(B) to the extent permitted by the Employee Retirement Income
Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health
benefit plan that is offered by:
(i) a multiple employer welfare arrangement as defined by
Section 3 of that Act; or
(ii) an analogous benefit arrangement; or
(2) is offered by:
(A) an approved nonprofit health corporation that holds a
certificate of authority under Chapter 844; or
(B) another entity that:
(i) is not authorized under this code or another insurance law
of this state; and
(ii) contracts directly for health care services on a
risk-sharing basis, including a capitation basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1503.002. EXCEPTION. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a period during
which an employee is absent from work because of sickness or
injury; or
(D) as a supplement to a liability insurance policy;
(2) a small employer health benefit plan written under Chapter
1501;
(3) a Medicare supplemental policy as defined by Section
1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), as
amended;
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under a motor
vehicle insurance policy; or
(6) a long-term care insurance 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 1503.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1503.003. COVERAGE OF CERTAIN STUDENTS. (a) A health
benefit plan may not condition coverage for a child younger than
25 years of age on the child' s being enrolled at an educational
institution.
(b) A health benefit plan that requires as a condition of
coverage for a child 25 years of age or older that the child be a
full-time student at an educational institution must provide the
coverage:
(1) for the entire academic term during which the child begins
as a full-time student and remains enrolled, regardless of
whether the number of hours of instruction for which the child is
enrolled is reduced to a level that changes the child's academic
status to less than that of a full-time student; and
(2) continuously until the 10th day of instruction of the
subsequent academic term, on which date the health benefit plan
may terminate coverage for the child if the child does not return
to full-time student status before that date.
(c) For purposes of this section, determination of the full-time
student status of a child is made in the manner provided by the
educational institution at which the child is enrolled.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.063(a), eff. September 1, 2005.
State Codes and Statutes
Statutes > Texas > Insurance-code > Title-8-health-insurance-and-other-health-coverages > Chapter-1503-coverage-of-certain-students
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE G. HEALTH COVERAGE AVAILABILITY
CHAPTER 1503. COVERAGE OF CERTAIN STUDENTS
Sec. 1503.001. APPLICABILITY OF CHAPTER. This chapter applies
only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses incurred
as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise insurance policy
or insurance agreement, a group hospital service contract, or an
individual or group evidence of coverage that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation operating under
Chapter 842;
(iii) a fraternal benefit society operating under Chapter 885;
(iv) a stipulated premium company operating under Chapter 884;
or
(v) a health maintenance organization operating under Chapter
843; and
(B) to the extent permitted by the Employee Retirement Income
Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health
benefit plan that is offered by:
(i) a multiple employer welfare arrangement as defined by
Section 3 of that Act; or
(ii) an analogous benefit arrangement; or
(2) is offered by:
(A) an approved nonprofit health corporation that holds a
certificate of authority under Chapter 844; or
(B) another entity that:
(i) is not authorized under this code or another insurance law
of this state; and
(ii) contracts directly for health care services on a
risk-sharing basis, including a capitation basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1503.002. EXCEPTION. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a period during
which an employee is absent from work because of sickness or
injury; or
(D) as a supplement to a liability insurance policy;
(2) a small employer health benefit plan written under Chapter
1501;
(3) a Medicare supplemental policy as defined by Section
1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), as
amended;
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under a motor
vehicle insurance policy; or
(6) a long-term care insurance 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 1503.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1503.003. COVERAGE OF CERTAIN STUDENTS. (a) A health
benefit plan may not condition coverage for a child younger than
25 years of age on the child' s being enrolled at an educational
institution.
(b) A health benefit plan that requires as a condition of
coverage for a child 25 years of age or older that the child be a
full-time student at an educational institution must provide the
coverage:
(1) for the entire academic term during which the child begins
as a full-time student and remains enrolled, regardless of
whether the number of hours of instruction for which the child is
enrolled is reduced to a level that changes the child's academic
status to less than that of a full-time student; and
(2) continuously until the 10th day of instruction of the
subsequent academic term, on which date the health benefit plan
may terminate coverage for the child if the child does not return
to full-time student status before that date.
(c) For purposes of this section, determination of the full-time
student status of a child is made in the manner provided by the
educational institution at which the child is enrolled.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.063(a), eff. September 1, 2005.
State Codes and Statutes
Statutes >
Texas >
Insurance-code >
Title-8-health-insurance-and-other-health-coverages >
Chapter-1503-coverage-of-certain-students INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE G. HEALTH COVERAGE AVAILABILITY
CHAPTER 1503. COVERAGE OF CERTAIN STUDENTS
Sec. 1503.001. APPLICABILITY OF CHAPTER. This chapter applies
only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses incurred
as a result of a health condition, accident, or sickness,
including:
(A) an individual, group, blanket, or franchise insurance policy
or insurance agreement, a group hospital service contract, or an
individual or group evidence of coverage that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation operating under
Chapter 842;
(iii) a fraternal benefit society operating under Chapter 885;
(iv) a stipulated premium company operating under Chapter 884;
or
(v) a health maintenance organization operating under Chapter
843; and
(B) to the extent permitted by the Employee Retirement Income
Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health
benefit plan that is offered by:
(i) a multiple employer welfare arrangement as defined by
Section 3 of that Act; or
(ii) an analogous benefit arrangement; or
(2) is offered by:
(A) an approved nonprofit health corporation that holds a
certificate of authority under Chapter 844; or
(B) another entity that:
(i) is not authorized under this code or another insurance law
of this state; and
(ii) contracts directly for health care services on a
risk-sharing basis, including a capitation basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1503.002. EXCEPTION. This chapter does not apply to:
(1) a plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a period during
which an employee is absent from work because of sickness or
injury; or
(D) as a supplement to a liability insurance policy;
(2) a small employer health benefit plan written under Chapter
1501;
(3) a Medicare supplemental policy as defined by Section
1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss), as
amended;
(4) a workers' compensation insurance policy;
(5) medical payment insurance coverage provided under a motor
vehicle insurance policy; or
(6) a long-term care insurance 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 1503.001.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1503.003. COVERAGE OF CERTAIN STUDENTS. (a) A health
benefit plan may not condition coverage for a child younger than
25 years of age on the child' s being enrolled at an educational
institution.
(b) A health benefit plan that requires as a condition of
coverage for a child 25 years of age or older that the child be a
full-time student at an educational institution must provide the
coverage:
(1) for the entire academic term during which the child begins
as a full-time student and remains enrolled, regardless of
whether the number of hours of instruction for which the child is
enrolled is reduced to a level that changes the child's academic
status to less than that of a full-time student; and
(2) continuously until the 10th day of instruction of the
subsequent academic term, on which date the health benefit plan
may terminate coverage for the child if the child does not return
to full-time student status before that date.
(c) For purposes of this section, determination of the full-time
student status of a child is made in the manner provided by the
educational institution at which the child is enrolled.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2005, 79th Leg., Ch.
728, Sec. 11.063(a), eff. September 1, 2005.
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