This is a clone of the Texas Administrative Code (TAC) for educational purposes. It is not the official version and should not be used for legal purposes. Site created Wed, 21 May 2025 21:16:48 GMT
(a) Unless otherwise provided by law or this subchapter, every individual accident and sickness insurance policy or subscriber contract that is subject to the provisions of this subchapter and that is delivered, issued for delivery or renewed on or after the effective date of this subchapter must comply with and contain definitions in conformance with those in subsection (b) of this subchapter.(b) The following words and terms, when used in this subchapter, shall have the following meanings, unless the context clearly indicates otherwise:(1) Aggregate period--Cumulative total of all time covered under creditable coverage without a significant break in coverage.(2) Church plan--A plan within the meaning of §3(33) of the Employee Retirement and Income Security Act of 1974, codified at 29 USC 1001, et seq. (ERISA).(3) Commissioner--The commissioner of insurance of the State of Texas.(4) Creditable coverage--As used in this subchapter, is defined as stated in §21.1101 of this title (relating to Definitions) of Chapter 21, Subchapter K of this title (relating to Certification of Creditable Coverage).(5) Department--The Texas Department of Insurance.(6) Excepted benefits--(A) Under all circumstances:(i) Coverage only for accident, including accidental death and dismemberment, such as coverage offered in accordance with §3.3076 of this title (relating to Minimum Standards for Accident Only Coverage);(ii) Disability income insurance, including coverage offered in accordance with §3.3075 of this title (relating to Minimum Standards for Disability Income Protection Coverage);(iii) Coverage for on-site medical clinics; and(iv) Short-term limited duration coverage.(B) Only if the benefits are provided under a separate policy or contract of insurance:(i) Dental or vision benefits that are limited in scope to a narrow range or type of benefits and that are generally excluded from policies that combine hospital, medical, or surgical benefits.(ii) Coverage only for a specified disease or illness (for example, cancer policies), or hospital indemnity or other fixed indemnity insurance (for example, "Hospital Confinement Indemnity Coverage," as defined in §3.3073 of this title (relating to Minimum Standards for Hospital Confinement Indemnity Coverage), provided that:(I) there is no coordination between the provision of benefits and benefits provided under any other policy; and(II) benefits are paid with respect to a covered event regardless of whether benefits are provided with respect to the same event under any other policy;(iii) coverage supplemental to the coverage provided under Chapter 55,