Sec. 1355.253. EXCEPTIONS. (a) This subchapter does not apply to:
(1) a plan that provides coverage:
(A) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;
(B) as a supplement to a liability insurance policy;
(C) for credit insurance;
(D) only for dental or vision care;
(E) only for hospital expenses;
(F) only for indemnity for hospital confinement; or
(G) only for accidents;
(2) a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss(g)(1));
(3) a workers' compensation insurance policy;
(4) medical payment insurance coverage provided under a motor vehicle insurance policy; or
(5) a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Section 1355.252.
(b) To the extent that this section would otherwise require this state to make a payment under 42 U.S.C. Section 18031(d)(3)(B)(ii), a qualified health plan, as defined by 45 C.F.R. Section 155.20, is not required to provide a benefit under this subchapter that exceeds the specified essential health benefits required under 42 U.S.C. Section 18022(b).
Added by Acts 2017, 85th Leg., R.S., Ch. 769 (H.B. 10), Sec. 2, eff. September 1, 2017.
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