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