CHAPTER 1454. EQUAL HEALTH CARE FOR WOMEN
INSURANCE CODE
TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES
SUBTITLE F. PHYSICIANS AND HEALTH CARE PROVIDERS
CHAPTER 1454. EQUAL HEALTH CARE FOR WOMEN
SUBCHAPTER A. GENERAL PROVISIONS
Sec. 1454.001. DEFINITIONS. In this chapter:
(1) "Health care provider" means a home health aide, hospital,
nurse practitioner, nurse midwife, outpatient care center,
physician assistant, registered nurse, or surgery center.
(2) "Physician" has the meaning assigned by Section 151.002,
Occupations Code.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.002. 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 insurance agreement, a group
hospital service contract, or an individual or group evidence of
coverage or similar coverage document that is offered by:
(1) an insurance company;
(2) a group hospital service corporation operating under Chapter
842;
(3) a fraternal benefit society operating under Chapter 885;
(4) a stipulated premium company operating under Chapter 884;
(5) a reciprocal exchange operating under Chapter 942;
(6) a health maintenance organization operating under Chapter
843;
(7) a multiple employer welfare arrangement that holds a
certificate of authority under Chapter 846;
(8) an approved nonprofit health corporation that holds a
certificate of authority under Chapter 844; or
(9) a small employer health benefit plan written under Chapter
1501.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
SUBCHAPTER B. REIMBURSEMENT FOR HEALTH CARE SERVICES
Sec. 1454.051. EQUAL REIMBURSEMENT REQUIRED. A health benefit
plan issuer that reimburses a physician or health care provider
for reproductive health or oncology services provided to women
must reimburse the physician or provider in an amount at least
equal to the annual average compensation per hour or unit that
would be paid in the service area to a physician or provider for
the same medical, surgical, hospital, pharmaceutical, nursing, or
other similar resources used to provide the services if the
resources would be used to provide health services exclusively to
men or to the general population.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.052. REIMBURSEMENT FOR ABORTION NOT REQUIRED. This
chapter does not require a health benefit plan issuer to provide
reimbursement for an abortion, as defined by the Family Code, or
for a service related to an abortion.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
SUBCHAPTER C. ENFORCEMENT
Sec. 1454.101. SANCTIONS AUTHORIZED. The sanctions authorized
by Chapter 82 apply to a health benefit plan issuer that violates
this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.102. CEASE AND DESIST PROCEDURES AND RESTITUTION FOR
ATTORNEY'S FEES AUTHORIZED. The commissioner may use the cease
and desist procedures authorized by Chapter 83 against a health
benefit plan issuer that violates this chapter. In accordance
with Chapter 83, the commissioner may order the health benefit
plan issuer to make complete restitution for the violation, which
may include restitution for the reasonable attorney's fees
incurred by a person making a complaint under this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.103. ADMINISTRATIVE PENALTIES AUTHORIZED. (a) In
addition to any sanctions authorized by this subchapter, the
commissioner may impose an administrative penalty in accordance
with Chapter 84 on a health benefit plan issuer that violates
this chapter.
(b) On a finding that a health benefit plan issuer knowingly
violated this chapter, the commissioner may impose in addition to
the administrative penalty authorized by Section 84.022 an
administrative penalty that does not exceed $25,000.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.104. AMOUNT OF DAMAGES. Notwithstanding this
subchapter, in imposing a sanction or penalty for a violation of
this chapter, the commissioner may order a health benefit plan
issuer to pay the greater of complete or economic damages.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.105. APPLICABILITY OF CERTAIN PROCEDURAL REQUIREMENTS
TO SANCTIONS OR ADMINISTRATIVE PENALTIES. Subchapter C, Chapter
84, applies to the imposition of a sanction or administrative
penalty under this chapter.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.106. INTERVENTION IN PROCEEDING. (a) In a proceeding
relating to the imposition by the commissioner of a sanction or
administrative penalty under this chapter, a person affected by
an order of the commissioner, including a physician or health
care provider, may intervene in the proceeding by filing a notice
of intervention with the commissioner. The commissioner shall
provide an affected person a reasonable period to intervene.
(b) At the time the commissioner notifies a health benefit plan
issuer of the issuer's opportunity for a hearing regarding an
alleged violation, the commissioner shall notify each affected
person of all relevant information regarding the hearing.
(c) A person who intervenes under this section has the rights
and powers of a party under Chapter 2001, Government Code.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.107. TIME FOR COMMISSIONER'S DETERMINATION. Not later
than the 120th day after the date a complaint alleging a
violation of this chapter is filed with the department, the
commissioner shall determine whether the alleged violation
occurred and impose appropriate sanctions.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.108. FAILURE OF COMMISSIONER TO MAKE DETERMINATION BY
ORDER; ACTION IN DISTRICT COURT. (a) If the commissioner fails
to determine by order in the time prescribed by Section 1454.107
whether a violation alleged in a complaint filed under this
chapter occurred, the person who filed the complaint may bring an
action in district court for the violation.
(b) The action must be commenced not later than the first
anniversary of the date by which the commissioner is required to
make a determination under Section 1454.107.
(c) In an action filed under this section, a court may:
(1) impose the sanctions authorized by this subchapter or
similar sanctions;
(2) assess an additional civil penalty of $25,000 if the trier
of fact finds the defendant knowingly violated this chapter; and
(3) award a claimant who prevails in an action filed under this
section reasonable attorney's fees and court costs, including
reasonable and necessary expert witness fees.
(d) On a finding by the court that an action filed under this
section was groundless and brought in bad faith or brought for
the purpose of harassment, the court shall award the defendant
reasonable and necessary attorney's fees.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.
Sec. 1454.109. APPEAL OF COMMISSIONER'S ORDER. (a) A person
affected by an order of the commissioner regarding a violation of
this chapter, including a person who intervenes under Section
1454.106, may file an appeal in district court.
(b) The standard of review for an appeal filed under this
section is substantial evidence.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1,
2005.