CHAPTER 1203. COORDINATION OF BENEFITS PROVISIONS
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.