1. Sec. 1214.001. APPLICABILITY OF CHAPTER. This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or agreement, a group hospital service contract, or an individual or group evidence of coverage issued by:
    1. (1) an insurance company;
    2. (2) a group hospital service corporation operating under Chapter 842;
    3. (3) a health maintenance organization operating under Section 1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507, Chapter 222, 251, or 258, as applicable to a health maintenance organization, Chapter 843, Chapter 1271, and Chapter 1272; or
    4. (4) an approved nonprofit health corporation holding a certificate of authority under Chapter 844.
    Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.001, eff. April 1, 2009.
  1. Sec. 1214.002. EXCEPTION. This chapter does not apply to:
    1. (1) a health benefit plan that provides coverage:
      1. (A) only for a specified disease;
      2. (B) only for accidental death or dismemberment; or
      3. (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
    2. (2) a long-term care insurance policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefits so comprehensive that the policy is a health benefit plan as described by Section 1214.001.
    Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.001, eff. April 1, 2009.
  1. Sec. 1214.003. RATE INFORMATION DISCLAIMERS. (a) Subject to Chapter 541 and Section 543.001, an advertisement for a health benefit plan may include rate information without including information about each benefit exclusion or limitation if the advertisement includes prominent disclaimers clearly indicating that:
    1. (1) the rates are illustrative;
    2. (2) a person should not send money to the health benefit plan issuer in response to the advertisement;
    3. (3) a person cannot obtain coverage under the plan until the person completes an application for coverage; and
    4. (4) benefit exclusions or limitations may apply to the plan.
  2. (b) An advertisement that states a rate must also indicate the age, gender, and geographic location on which the rate is based.
  3. Added by Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 1G.001, eff. April 1, 2009.


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