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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle E. BENEFITS PAYABLE UNDER HEALTH COVERAGES |
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Chapter 1355. BENEFITS FOR CERTAIN MENTAL DISORDERS |
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Subchapter A. GROUP HEALTH BENEFIT PLAN COVERAGE FOR CERTAIN SERIOUS MENTAL ILLNESSES AND OTHER DISORDERS |
Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS
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(a) A group health benefit plan:
(1) must provide coverage, based on medical necessity, for not less than the following treatments of serious mental illness in each calendar year:
(A) 45 days of inpatient treatment; and
(B) 60 visits for outpatient treatment, including group and individual outpatient treatment;
(2) may not include a lifetime limitation on the number of days of inpatient treatment or the number of visits for outpatient treatment covered under the plan; and
(3) must include the same amount limitations, deductibles, copayments, and coinsurance factors for serious mental illness as the plan includes for physical illness.
(b) A group health benefit plan issuer:
(1) may not count an outpatient visit for medication management against the number of outpatient visits required to be covered under Subsection (a)(1)(B); and
(2) must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.