Texas Insurance Code 1205.004 – Creditable Coverage
(a) An individual’s coverage is creditable coverage for purposes of this chapter if the coverage is provided under:
(1) a self-funded or self-insured employee welfare benefit plan that:
(A) provides health benefits; and
(B) is established in accordance with the Employee Retirement Income Security Act of 1974 (29 U.S.C. § 1001 et seq.);
(2) a group health benefit plan provided by a health insurer or health maintenance organization;
(3) an individual health insurance policy or evidence of coverage;
(4) Part A or Part B of Title XVIII of the Social Security Act (42 U.S.C. § 1395c et seq.);
(5) Title XIX of the Social Security Act (42 U.S.C. § 1396 et seq.), other than coverage consisting solely of benefits under Section 1928 of that act (42 U.S.C. § 1396s);
(6) 10 U.S.C. § 1071 et seq.;
(7) a medical care program of the Indian Health Service or of a tribal organization;
(8) a state health benefits risk pool;
(9) a health plan offered under 5 U.S.C. § 8901 et seq.;
(10) a public health plan as defined by federal regulations; or
(11) a health benefit plan under Section 5(e), Peace Corps Act (22 U.S.C. § 2504(e)).
(b) For purposes of this chapter, creditable coverage does not include:
(1) accident-only or disability income insurance or a combination of accident-only and disability income insurance;
(2) coverage issued as a supplement to liability insurance;
(3) liability insurance, including general liability insurance and automobile liability insurance;
(4) workers’ compensation insurance or other similar insurance;
(5) automobile medical payment insurance;
(6) credit-only insurance;
(7) coverage for on-site medical clinics;
(8) other coverage that is:
(A) similar to the coverage described by this subsection under which benefits for medical care are secondary or incidental to other insurance benefits; and
(B) specified by federal regulations;
(9) coverage that provides limited-scope dental or vision benefits;
(10) long-term care, nursing home care, home health care, or community-based care coverage or benefits or any combination of those coverages or benefits;
(11) coverage that provides other limited benefits specified by federal regulations;
(12) coverage for a specified disease or illness;
(13) hospital indemnity or other fixed indemnity insurance; or
(14) Medicare supplemental health insurance, as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. § 1395ss), coverage supplemental to the coverage provided under 10 U.S.C. § 1071 et seq., or other similar supplemental coverage provided under a group plan.
Terms Used In Texas Insurance Code 1205.004
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.