Texas Insurance Code 1253.001 – Limitation of Services and Benefits On Contract Renegotiation
(a) In this section, “health benefit contract” means a contract providing group health care coverage for employees that is delivered, issued for delivery, or renewed in this state by:
(1) an insurance company;
(2) a group hospital service corporation operating under Chapter 842; or
(3) a health maintenance organization operating under Chapter 843.
(b) Subject to Subsection (c), if an employer in this state agrees to renegotiate a health benefit contract, a change in the renegotiated contract may not operate solely to terminate eligibility with respect to any member of the group who, before the contract was renegotiated:
(1) was covered under the contract; and
(2) had a sickness or injury for which a service was being provided or a benefit was being paid under the contract.
Terms Used In Texas Insurance Code 1253.001
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
(c) A renegotiated health benefit contract may include a different durational or dollar limit or a different deductible amount or amount of coinsurance applicable to a sickness or injury for which a service was being provided or benefit was being paid before the contract was renegotiated if that same or a similar limit or amount applies to a service provided or benefit paid for a similar sickness or a related condition or injury covered by the contract.