Tex. Ins. Code § 1507.053 · Subchapter B. CONSUMER CHOICE OF BENEFITS HEALTH MAINTENANCE ORGANIZATION 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 evidence of coverage 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, including limitations provided in Section 1271.151; or
(3) includes a specific category of licensed health care practitioner from whom an enrollee is entitled to receive care.
(b) For purposes of this subchapter, "state-mandated health benefits" does not include coverage that is mandated by federal law or standard provisions or rights required under this code or other laws of this state to be provided in an evidence of coverage that are unrelated to a specific health illness, injury, or condition of an enrollee, including provisions related to:
(1) continuation of coverage under Subchapter G, Chapter 1251;
(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) Chapter 1504;
(B) Chapter 1503;
(C) Section 1501.157;
(D) Section 1501.158; and
(E) Sections 1501.607-1501.609;
(5) services of providers under Section 843.304;
(6) coverage for serious mental health illness under Subchapter A, Chapter 1355; and
(7) 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.030(a), eff. September 1, 2007.
Acts 2007, 80th Leg., R.S., Ch. 921 (H.B. 3167), Sec. 9.030(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 82e84f81c4106b39590f6844479d1fb4fa4b557009f60cf6bb8548a7f15bb970
- 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 § 843.304EXCLUSION OF PROVIDER BASED ON TYPE OF LICENSE PROHIBITED.Printed as Section 843.304
- 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. 1251, subch. GCONTINUATION OF GROUP COVERAGE FOR CERTAIN FAMILY MEMBERS AND DEPENDENTSPrinted as Subchapter G, Chapter 1251
- Tex. Ins. Code § 1271.151PROVISION OF BASIC HEALTH CARE SERVICES.Printed as Section 1271.151
- 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. 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 § 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
Provisions in this library whose text cites Tex. Ins. Code § 1507.053. Each shows the citation as that text prints it.
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