CHAPTER 1504. MEDICAL CHILD SUPPORT
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE G. HEALTH COVERAGE AVAILABILITY
CHAPTER 1504. MEDICAL CHILD SUPPORT
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1504.001. DEFINITIONS. In this chapter:
(1) "Child" has the meaning assigned by Section 101.003, Family
Code.
(2) "Child support agency" has the meaning assigned by Section
101.004, Family Code.
(3) "Custodial parent" means an individual who:
(A) is a managing conservator of a child or a possessory
conservator of a child who is a parent of the child; or
(B) is a guardian of the person or other custodian of a child
and is designated as guardian or custodian by a court or
administrative agency of this or another state.
(4) "Health benefit plan issuer" means:
(A) an insurance company, group hospital service corporation, or
health maintenance organization that delivers or issues for
delivery an individual, group, blanket, or franchise insurance
policy or agreement, a group hospital service contract, or an
evidence of coverage that provides benefits for medical or
surgical expenses incurred as a result of an accident or
sickness;
(B) a governmental entity subject to Subchapter D, Chapter 1355,
Subchapter C, Chapter 1364, Chapter 1578, Article 3.51-1, 3.51-4,
or 3.51-5, or Chapter 177, Local Government Code;
(C) the issuer of a multiple employer welfare arrangement as
defined by Section 846.001; or
(D) the issuer of a group health plan as defined by Section 607,
Employee Retirement Income Security Act of 1974 (29 U.S.C.
Section 1167).
(5) "Medical assistance" means medical assistance under the
state Medicaid program.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch.
730, Sec. 2G.016, eff. April 1, 2009.
Sec. 1504.002. RULES. (a) The commissioner shall adopt
reasonable rules as necessary to implement this chapter and 42
U.S.C. Section 1396a(a)(60), including rules that define acts
that constitute unfair or deceptive practices under Subchapter I,
Chapter 541.
(b) The commissioner shall adopt rules that define "comparable
health coverage" in a manner that:
(1) is consistent with federal law; and
(2) complies with the requirements necessary to maintain federal
Medicaid funding.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1504.003. VIOLATION OF CHAPTER: RELIEF AVAILABLE TO INJURED
PERSON. A health benefit plan issuer that violates this chapter
is subject to the same penalties, and an injured person has the
same rights and remedies, as those provided by Subchapter D,
Chapter 541.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
SUBCHAPTER B. DUTIES OF HEALTH BENEFIT PLAN ISSUER
Sec. 1504.051. ENROLLMENT OF CERTAIN CHILDREN REQUIRED. (a) A
health benefit plan issuer shall permit a parent to enroll a
child in dependent health coverage offered through the issuer
regardless of any enrollment period restriction if the parent is:
(1) eligible for dependent health coverage; and
(2) required by a court order or administrative order to provide
health insurance coverage for the child.
(b) A health benefit plan issuer shall enroll a child of a
parent described by Subsection (a) in dependent health coverage
offered through the issuer if:
(1) the parent does not apply to obtain health coverage for the
child through the issuer; and
(2) the child, a custodial parent of the child, or a child
support agency having a duty to collect or enforce support for
the child applies for the coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1504.052. CHILD RESIDING OUTSIDE SERVICE AREA; COMPARABLE
HEALTH COVERAGE REQUIRED. (a) A health benefit plan issuer may
not deny enrollment of a child under the health coverage of the
child's parent on the ground that the child does not reside in
the issuer's service area.
(b) A health benefit plan issuer may not enforce an otherwise
applicable provision of the health coverage that would deny,
limit, or reduce payment of a claim for a covered child who
resides outside the issuer's service area but inside the United
States.
(c) For a covered child who resides outside the health benefit
plan issuer's service area and whose coverage under a policy or
plan is required by a medical support order, the issuer shall
provide coverage that is comparable health coverage to that
provided to other dependents under the policy or plan.
(d) Comparable health coverage may include coverage in which a
health benefit plan issuer uses different procedures for service
delivery and health care provider reimbursement. Comparable
health coverage may not include coverage:
(1) that is limited to emergency services only; or
(2) for which the issuer charges a higher premium.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1504.053. CANCELLATION OR NONRENEWAL OF COVERAGE FOR
CERTAIN CHILDREN. (a) A health benefit plan issuer may not
cancel or refuse to renew health coverage provided to a child who
is enrolled or entitled to enrollment under this chapter unless
satisfactory written evidence is filed with the issuer showing
that:
(1) the court or administrative order that required the coverage
is not in effect; or
(2) the child:
(A) is enrolled in comparable health coverage; or
(B) will be enrolled in comparable health coverage that takes
effect not later than the effective date of the cancellation or
nonrenewal.
(b) For purposes of this section, a child is not enrolled or
entitled to enrollment under this chapter if the child's
eligibility for health coverage ends because the parent ceases to
be eligible for dependent health coverage.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1504.054. CONTINUATION OR CONVERSION OF COVERAGE. (a) If
a child's eligibility for dependent health coverage ends because
the parent ceases to be eligible for the coverage and the
coverage provides for the continuation or conversion of the
coverage for the child, the health benefit plan issuer shall
notify the custodial parent and the child support agency of the
costs and other requirements for continuing or converting the
coverage.
(b) The health benefit plan issuer shall, on application of a
parent of the child, a child support agency, or the child, enroll
or continue enrollment of a child whose eligibility for coverage
ended under Subsection (a).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1504.055. PROCEDURE FOR CLAIMS. (a) A health benefit plan
issuer that provides health coverage to a child through a covered
parent of the child shall:
(1) provide to each custodial parent of the child or to an adult
child documents and other information necessary for the child to
obtain benefits under the coverage, including:
(A) the name of the issuer;
(B) the number of the policy or evidence of coverage;
(C) a copy of the policy or evidence of coverage and schedule of
benefits;
(D) a health coverage membership card;
(E) claim forms; and
(F) any other document or information necessary to submit a
claim in accordance with the issuer's policies and procedures;
(2) permit a custodial parent, health care provider, state
agency that has been assigned medical support rights, or adult
child to submit claims for covered services without the approval
of the covered parent; and
(3) make payments on covered claims submitted in accordance with
this subsection directly to a custodial parent, health care
provider, adult child, or state agency making a claim.
(b) A health benefit plan issuer shall provide to a state agency
that provides medical assistance to the child or shall provide to
a child support agency that enforces medical support on behalf of
a child the information necessary to obtain reimbursement of
medical services provided to or paid on behalf of the child.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
SUBCHAPTER C. PROHIBITED CONDUCT
Sec. 1504.101. DENIAL OF ENROLLMENT ON CERTAIN GROUNDS
PROHIBITED. A health benefit plan issuer may not deny enrollment
of a child under the health coverage of the child's parent on the
ground that the child:
(1) has a preexisting condition;
(2) was born out of wedlock;
(3) is not claimed as a dependent on the parent's federal income
tax return;
(4) does not reside with the parent; or
(5) receives or has applied for medical assistance.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1504.102. ASSIGNMENT OF MEDICAL SUPPORT RIGHTS: DIFFERENT
REQUIREMENTS PROHIBITED. A health benefit plan issuer may not
require a state agency that has been assigned the rights of an
individual who is eligible for medical assistance and is covered
for health benefits from the issuer to comply with a requirement
that is different from a requirement imposed on an agent or
assignee of any other covered individual.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.