INSURANCE CODE - NOT CODIFIED
CHAPTER 27. HEALTH BENEFIT PLANS FOR CHILDREN
Art. 27.01. Definition
In this chapter, "health benefit plan" means a health benefit plan
described by Article 27.02 of this code.
Added by Acts 1997, 75th Leg., ch. 550, Sec. 4, eff. June 2, 1997.
Art. 27.02. Scope of Chapter
This chapter applies to a health benefit plan that:
(1) provides benefits for medical or surgical expenses incurred as
a result of a health condition, accident, or sickness, including:
(A) an individual, group, blanket, or franchise insurance policy or
insurance agreement, a group hospital service contract, or an
individual or group evidence of coverage that is offered by:
(i) an insurance company;
(ii) a group hospital service corporation operating under Chapter
20 of this code;
(iii) a fraternal benefit society operating under Chapter 10 of
this code;
(iv) a stipulated premium insurance company operating under Chapter
22 of this code; or
(v) a health maintenance organization operating under the Texas
Health Maintenance Organization Act (Chapter 20A, Vernon's Texas
Insurance Code); or
(B) to the extent permitted by the Employee Retirement Income
Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health
benefit plan that is offered by:
(i) a multiple employer welfare arrangement as defined by Section
3, Employee Retirement Income Security Act of 1974 (29 U.S.C.
Section 1002) or another analogous benefit arrangement; or
(ii) any other entity not licensed under this code or another
insurance law of this state that contracts directly for health care
services on a risk sharing basis, including an entity that
contracts for health care services on a capitation basis; or
(2) is offered by an approved nonprofit health corporation that is
certified under Section 5.01(a), Medical Practice Act (Article
4495b, Vernon's Texas Civil Statutes), and that holds a certificate
of authority issued by the commissioner under Article 21.52F of
this code.
Added by Acts 1997, 75th Leg., ch. 550, Sec. 4, eff. June 2, 1997.
Art. 27.03. Children's Health Benefit Plan
(a) The issuer of a health benefit plan may offer a children's
health benefit plan in accordance with this chapter. The health
benefit plan may provide coverage only to children younger than 18
years of age.
(b) An issuer of a health benefit plan may not offer a children's
health benefit plan under this chapter unless the plan's structure
and the benefits offered under the plan have been approved by the
commissioner.
Added by Acts 1997, 75th Leg., ch. 550, Sec. 4, eff. June 2, 1997.
Art. 27.04. Mandated Benefit Provisions Inapplicable
A children's health benefit plan is not subject to a law that
requires coverage or the offer of coverage of a health care service
or benefit.
Added by Acts 1997, 75th Leg., ch. 550, Sec. 4, eff. June 2, 1997.
Art. 27.05. Exemption From Premium Tax
The issuer of a children's health benefit plan approved under
Article 27.03 of this code is not subject to the premium tax imposed
by Article 4.11 of this code or the tax on revenues imposed under
Section 33, Texas Health Maintenance Organization Act (Article
20A.33, Vernon's Texas Insurance Code), with respect to money
received for coverage provided under that plan.
Added by Acts 1997, 75th Leg., ch. 550, Sec. 4, eff. June 2, 1997.
Amended by Acts 2003, 78th Leg., ch. 198, Sec. 2.124, eff. Sept. 1,
2003.
Art. 27.06. Rules
The commissioner may adopt rules to implement this chapter.
Added by Acts 1997, 75th Leg., ch. 550, Sec. 4, eff. June 2, 1997.
Art. 27.07. Inapplicability to Certain Plans
This chapter does not apply to a health benefit plan provided under
the state Medicaid program or the state child health plan.
Added by Acts 2003, 78th Leg., ch. 198, Sec. 2.125, eff. Sept. 1,
2003.
