Texas Insurance Code 1204.252 – Preconditions for Payment; Exceptions
(a) In accordance with the terms of the policy and this subchapter, an insurer or group hospital service corporation may be required to pay benefits under a group accident and health insurance policy to a person who is not a group member and who complies with:
(1) § 1204.251;
(2) the insurer’s or group hospital service corporation’s claim application procedures; and
(3) department rules.
(b) Any requirement imposed on a possessory or managing conservator of a child under this subchapter does not apply with regard to:
(1) an unpaid medical bill for which an assignment of benefits has been exercised, whether in accordance with policy provisions or otherwise; or
(2) a claim presented by a group member for which the group member paid any portion of a medical bill that is covered under the policy’s terms.
Terms Used In Texas Insurance Code 1204.252
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Person: includes corporation, organization, government or governmental subdivision or agency, business trust, estate, trust, partnership, association, and any other legal entity. See Texas Government Code 311.005