CHAPTER 1214. ADVERTISING FOR CERTAIN HEALTH BENEFITS

INSURANCE CODE

TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES

SUBTITLE A. HEALTH COVERAGE IN GENERAL

CHAPTER 1214. ADVERTISING FOR CERTAIN HEALTH BENEFITS

Sec. 1214.001. APPLICABILITY OF CHAPTER. This chapter applies

only to a health benefit plan that provides benefits for medical

or surgical expenses incurred as a result of a health condition,

accident, or sickness, including an individual, group, blanket,

or franchise insurance policy or agreement, a group hospital

service contract, or an individual or group evidence of coverage

issued by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter

842;

(3) a health maintenance organization operating under Section

1367.053, Subchapter A, Chapter 1452, Subchapter B, Chapter 1507,

Chapter 222, 251, or 258, as applicable to a health maintenance

organization, Chapter 843, Chapter 1271, and Chapter 1272; or

(4) an approved nonprofit health corporation holding a

certificate of authority under Chapter 844.

Added by Acts 2007, 80th Leg., R.S., Ch.

730, Sec. 1G.001, eff. April 1, 2009.

Sec. 1214.002. EXCEPTION. This chapter does not apply to:

(1) a health benefit plan that provides coverage:

(A) only for a specified disease;

(B) only for accidental death or dismemberment; or

(C) for wages or payments in lieu of wages for a period during

which an employee is absent from work because of sickness or

injury; or

(2) a long-term care insurance policy, including a nursing home

fixed indemnity policy, unless the commissioner determines that

the policy provides benefits so comprehensive that the policy is

a health benefit plan as described by Section 1214.001.

Added by Acts 2007, 80th Leg., R.S., Ch.

730, Sec. 1G.001, eff. April 1, 2009.

Sec. 1214.003. RATE INFORMATION DISCLAIMERS. (a) Subject to

Chapter 541 and Section 543.001, an advertisement for a health

benefit plan may include rate information without including

information about each benefit exclusion or limitation if the

advertisement includes prominent disclaimers clearly indicating

that:

(1) the rates are illustrative;

(2) a person should not send money to the health benefit plan

issuer in response to the advertisement;

(3) a person cannot obtain coverage under the plan until the

person completes an application for coverage; and

(4) benefit exclusions or limitations may apply to the plan.

(b) An advertisement that states a rate must also indicate the

age, gender, and geographic location on which the rate is based.

Added by Acts 2007, 80th Leg., R.S., Ch.

730, Sec. 1G.001, eff. April 1, 2009.