Tex. Ins. Code § 1507.003 · Subchapter A. CONSUMER CHOICE OF BENEFITS HEALTH INSURANCE PLANS
STATE-MANDATED HEALTH BENEFITS.
Text — Current through the 89th 2nd Called Legislative Session, 2025
(a) For purposes of this subchapter, "state-mandated health benefits" means coverage required under this code or other laws of this state to be provided in an individual, blanket, or group policy for accident and health insurance or a contract for a health-related condition that:
(1) includes coverage for specific health care services or benefits;
(2) places limitations or restrictions on deductibles, coinsurance, copayments, or any annual or lifetime maximum benefit amounts; or
(3) includes a specific category of licensed health care practitioner from whom an insured is entitled to receive care.
(b) For purposes of this subchapter, "state-mandated health benefits" does not include benefits that are mandated by federal law or standard provisions or rights required under this code or other laws of this state to be provided in an individual, blanket, or group policy for accident and health insurance that are unrelated to a specific health illness, injury, or condition of an insured, including provisions related to:
(1) continuation of coverage under:
(A) Subchapters F and G, Chapter 1251;
(B) Section 1201.059; and
(C) Subchapter B, Chapter 1253;
(2) termination of coverage under Sections 1202.051 and 1501.108;
(3) preexisting conditions under Subchapter D, Chapter 1201, and Sections 1501.102-1501.105;
(4) coverage of children, including newborn or adopted children, under:
(A) Subchapter D, Chapter 1251;
(B) Sections 1201.053, 1201.061, 1201.063-1201.065, and Subchapter A, Chapter 1367;
(C) Chapter 1504;
(D) Chapter 1503;
(E) Section 1501.157;
(F) Section 1501.158; and
(G) Sections 1501.607-1501.609;
(5) services of practitioners under:
(A) Subchapters A, B, and C, Chapter 1451; or
(B) Section 1301.052;
(6) supplies and services associated with the treatment of diabetes under Subchapter B, Chapter 1358;
(7) coverage for serious mental illness under Subchapter A, Chapter 1355;
(8) coverage for childhood immunizations and hearing screening as required by Subchapters B and C, Chapter 1367, other than Section 1367.053(c) and Chapter 1353;
(9) coverage for reconstructive surgery for certain craniofacial abnormalities of children as required by Subchapter D, Chapter 1367;
(10) coverage for the dietary treatment of phenylketonuria as required by Chapter 1359;
(11) coverage for referral to a non-network physician or provider when medically necessary covered services are not available through network physicians or providers, as required by Section 1271.055; and
(12) coverage for cancer screenings under:
(A) Chapter 1356;
(B) Chapter 1362;
(C) Chapter 1363; and
(D) Chapter 1370.
Notes and commentary — not statutory text
History
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.074(a), eff. September 1, 2005.
Amended by:
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 3B.029(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.029(a), eff. September 1, 2007.
Source of truth
- Edition
- Current through the 89th 2nd Called Legislative Session, 2025
- Official file
- https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1507.htm
- Text hash
- sha256 8080ec3e7e50c865765fe0e296228eaf735da32e859ab2977ac457ca0428ccf9
- Composed by
- compose_tx.py 2026-10-05: the Legislative Council's chapter files read in document order; verify_tx.py's independent reading (lxml DOM walk) agrees character for character
This section cites
Provisions in this library that the text above cites, as it prints each citation. A range cited as “ss. 61.13-61.16” links its first and last provisions.
Insurance Code
- Tex. Ins. Code § 1201.053PERSONS INSURED.Printed as Sections 1201.053, 1201.061, 1201.063-1201.065
- Tex. Ins. Code § 1201.059TERMINATION OF COVERAGE BASED ON AGE OF CHILD IN INDIVIDUAL, BLANKET, OR GROUP POLICY.Printed as Section 1201.059
- Tex. Ins. Code § 1201.065AGE AND SCHOOL ENROLLMENT ELIGIBILITY CRITERIA FOR DEPENDENT CHILDREN IN INDIVIDUAL OR GROUP POLICY; LATE ENROLLMENT.Printed as Sections 1201.053, 1201.061, 1201.063-1201.065
- Tex. Ins. Code ch. 1201, subch. DPREEXISTING CONDITIONSPrinted as Subchapter D, Chapter 1201
- Tex. Ins. Code § 1202.051RENEWABILITY AND CONTINUATION OF INDIVIDUAL HEALTH INSURANCE POLICIES.Printed as Sections 1202.051 and 1501.108
- Tex. Ins. Code ch. 1251GROUP AND BLANKET HEALTH INSURANCEPrinted as Chapter 1251
- Tex. Ins. Code ch. 1251, subch. DGROUP ACCIDENT AND HEALTH INSURANCE: COVERAGE FOR DEPENDENTSPrinted as Subchapter D, Chapter 1251
- Tex. Ins. Code ch. 1253, subch. BCONTINUATION OF GROUP ACCIDENT AND HEALTH INSURANCE POLICIES DURING LABOR DISPUTEPrinted as Subchapter B, Chapter 1253
- Tex. Ins. Code § 1271.055OUT-OF-NETWORK SERVICES.Printed as Section 1271.055
- Tex. Ins. Code § 1301.052DESIGNATION OF ADVANCED PRACTICE NURSE OR PHYSICIAN ASSISTANT AS PREFERRED PROVIDER.Printed as Section 1301.052
- Tex. Ins. Code ch. 1353IMMUNIZATION OR VACCINATION PROTOCOLS UNDER MANAGED CARE PLANSPrinted as Chapter 1353
- Tex. Ins. Code ch. 1355, subch. AGROUP HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN SERIOUS MENTAL ILLNESSES AND OTHER DISORDERSPrinted as Subchapter A, Chapter 1355
- Tex. Ins. Code ch. 1356MAMMOGRAPHY AND OTHER BREAST IMAGINGPrinted as Chapter 1356
- Tex. Ins. Code ch. 1358, subch. BSUPPLIES AND SERVICES ASSOCIATED WITH DIABETES TREATMENTPrinted as Subchapter B, Chapter 1358
- Tex. Ins. Code ch. 1359FORMULAS FOR INDIVIDUALS WITH PHENYLKETONURIA OR OTHER HERITABLE DISEASESPrinted as Chapter 1359
- Tex. Ins. Code ch. 1362CERTAIN TESTS FOR DETECTION OF PROSTATE CANCERPrinted as Chapter 1362
- Tex. Ins. Code ch. 1363CERTAIN TESTS FOR DETECTION OF COLORECTAL CANCERPrinted as Chapter 1363
- Tex. Ins. Code ch. 1367COVERAGE OF CHILDRENPrinted as Chapter 1367
- Tex. Ins. Code ch. 1367, subch. ANEWBORN CHILDRENPrinted as Subchapter A, Chapter 1367
- Tex. Ins. Code § 1367.053COVERAGE REQUIRED.Printed as Section 1367.053(c)
- Tex. Ins. Code ch. 1367, subch. DCHILD CRANIOFACIAL ABNORMALITIESPrinted as Subchapter D, Chapter 1367
- Tex. Ins. Code ch. 1451ACCESS TO CERTAIN PRACTITIONERS AND FACILITIESPrinted as Chapter 1451
- Tex. Ins. Code § 1501.102PREEXISTING CONDITION PROVISION.Printed as Sections 1501.102-1501.105
- Tex. Ins. Code § 1501.105WAITING PERIOD PERMITTED.Printed as Sections 1501.102-1501.105
- Tex. Ins. Code § 1501.108RENEWABILITY OF COVERAGE; CANCELLATION.Printed as Sections 1202.051 and 1501.108
- Tex. Ins. Code § 1501.157COVERAGE FOR NEWBORN CHILDREN.Printed as Section 1501.157
- Tex. Ins. Code § 1501.158COVERAGE FOR ADOPTED CHILDREN.Printed as Section 1501.158
- Tex. Ins. Code § 1501.607COVERAGE FOR NEWBORN CHILDREN.Printed as Sections 1501.607-1501.609
- Tex. Ins. Code § 1501.609COVERAGE FOR UNMARRIED CHILDREN.Printed as Sections 1501.607-1501.609
- Tex. Ins. Code ch. 1503COVERAGE OF CERTAIN STUDENTSPrinted as Chapter 1503
- Tex. Ins. Code ch. 1504MEDICAL AND DENTAL CHILD SUPPORTPrinted as Chapter 1504
Cited by 1 provision
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