2005 Texas Insurance Code CHAPTER 1455. TELEMEDICINE AND TELEHEALTH

INSURANCE CODE

CHAPTER 1455. TELEMEDICINE AND TELEHEALTH


	§ 1455.001. DEFINITIONS.  In this chapter:                                  
		(1)  "Health professional" means:                                             
			(A)  a physician;                                                            
			(B)  an individual who is:                                                   
				(i)  licensed or certified in this state to 
perform health care services;  and
				(ii)  authorized to assist a physician in 
providing telemedicine medical services that are delegated and 
supervised by the physician;  or
			(C)  a licensed or certified health professional 
acting within the scope of the license or certification who does not 
perform a telemedicine medical service.
		(2)  "Physician" means a person licensed to practice 
medicine in this state under Subtitle B, Title 3, Occupations Code.
		(3)  "Telehealth service" and "telemedicine medical 
service" have the meanings assigned by Section 57.042, Utilities 
Code.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1455.002. APPLICABILITY OF CHAPTER.  This chapter 
applies only to a health benefit plan that:
		(1)  provides benefits for medical or surgical expenses 
incurred as a result of a health condition, accident, or sickness, 
including:
			(A)  an individual, group, blanket, or franchise 
insurance policy or insurance agreement, a group hospital service 
contract, or an individual or group evidence of coverage that is 
offered by:
				(i)  an insurance company;                                                  
				(ii)  a group hospital service corporation 
operating under Chapter 842;   
				(iii)  a fraternal benefit society operating 
under Chapter 885;           
				(iv)  a stipulated premium company operating 
under Chapter 884;  or       
				(v)  a health maintenance organization 
operating under Chapter 843;  and  
			(B)  to the extent permitted by the Employee 
Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et 
seq.), a health benefit plan that is offered by:
				(i)  a multiple employer welfare arrangement 
as defined by Section 3 of that Act;  or
				(ii)  another analogous benefit 
arrangement;  or                          
		(2)  is offered by an approved nonprofit health 
corporation that holds a certificate of authority under Chapter 
844.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1455.003. EXCEPTION.  This chapter does not apply to:                     
		(1)  a plan that provides coverage:                                           
			(A)  only for a specified disease;                                           
			(B)  only for accidental death or dismemberment;                             
			(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
			(D)  as a supplement to a liability insurance 
policy;                      
		(2)  a small employer health benefit plan written under 
Chapter 1501;       
		(3)  a Medicare supplemental policy as defined by 
Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss);
		(4)  a workers' compensation insurance policy;                                
		(5)  medical payment insurance coverage provided under 
a motor vehicle insurance policy;  or
		(6)  a long-term care insurance 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 1455.002.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1455.004. COVERAGE FOR TELEMEDICINE MEDICAL SERVICES 
AND TELEHEALTH SERVICES.  (a) A health benefit plan may not exclude 
a telemedicine medical service or a telehealth service from 
coverage under the plan solely because the service is not provided 
through a face-to-face consultation.
	(b)  A health benefit plan may require a deductible, a 
copayment, or coinsurance for a telemedicine medical service or a 
telehealth service.  The amount of the deductible, copayment, or 
coinsurance may not exceed the amount of the deductible, copayment, 
or coinsurance required for a comparable medical service provided 
through a face-to-face consultation.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.          


	§ 1455.005. RULES.  Subject to Section 111.004, 
Occupations Code, the commissioner may adopt rules necessary to 
implement this chapter.

Added by Acts 2003, 78th Leg., ch. 1274, § 3, eff. April 1, 2005.  
Amended by Acts 2005, 79th Leg., ch. 728, § 23.002(10), eff. 
Sept. 1, 2005.