28 Tex. Admin. Code § 3.3071 - Minimum Standards for Basic Hospital Expense Coverage
(a) "Basic hospital expense insurance" is a
policy of accident and health insurance which provides coverage for a period of
not less than 31 days during any one period of confinement for each person
insured under the policy for the expense incurred for necessary treatment and
services rendered as a result of an injury or sickness for at least the
following:
(1) daily hospital room and board
in an amount not less than:
(A) 80% of the
charges for semi-private room accommodations; or
(B) $30 per day;
(2) miscellaneous hospital services for
expenses incurred for the charges made by the hospital for services and
supplies which are customarily rendered by the hospital and provided for use
only during the period of continuous hospital confinement in an amount not less
than either 80% of the charges incurred up to at least $1,000 or 10 times the
daily hospital room and board benefit rate;
(3) hospital outpatient services:
(A) hospital services on the day surgery is
performed in an amount not less than $50; and
(B) hospital services rendered within 72
hours after accidental injury, in an amount not less than $50; and
(C) x-ray and laboratory tests to the extent
that benefits for such services would have been provided, in an amount not less
than $100, if rendered to an inpatient of the hospital;
(4) benefits provided under paragraphs (1)
and (2) of this section may be provided subject to a combined deductible amount
not in excess of $100 per period of confinement;
(5) if hospital confinement maternity
benefits are included within the scope of policy coverage then the amount of
the minimum benefits for each covered pregnancy shall be the actual expenses
incurred according to the policy terms up to an amount that is equal to 10
times the minimum daily hospital room and board benefit.
(b) Basic hospital expense insurance must be
guaranteed renewable in accordance with §
3.3020 of this title (relating to
Policy Definition of Guaranteed Renewable and Limited Guarantee of
Renewability) and §
3.3038 of this title (relating to
Mandatory Guaranteed Renewability Provisions for Individual Hospital, Medical
or Surgical Coverage; Exceptions) of this subchapter, unless such insurance
constitutes short-term limited duration coverage, as defined in §
3.3002(b)(18) of
this title (relating to Definitions).
Notes
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.