{"data":{"id":"us-tx/tex.-insurance-code-1351.007","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1351.007","heading":"LIMITATIONS AND EXCLUSIONS ON COVERAGE PERMITTED.","body":"(a) A group health benefit plan may include:\n(1) a limitation on the number of visits for home health services for which benefits are payable, subject to Subsection (b);\n(2) an exclusion for home health services coverage for:\n(A) custodial care;\n(B) services provided by an individual who:\n(i) resides in the covered individual's home; or\n(ii) is a member of the covered individual's family; or\n(C) services provided to a covered individual who is eligible for Medicare coverage;\n(3) annual deductible and coinsurance provisions for home health services coverage that are not less favorable than the deductible or coinsurance provisions applicable to hospital services coverage under the plan; and\n(4) other coverage limitations or exclusions consistent with the remaining provisions of the plan.\n(b) A limitation under Subsection (a)(1) may not limit each individual covered under the plan to fewer than 60 visits in any calendar year or continuous 12-month period.\n(c) For purposes of this section, each of the following is considered to be one visit for home health services:\n(1) a visit by a representative of a home health agency;\n(2) four hours of home health aide service; and\n(3) if home health aide service extends beyond four hours, each additional four hours or portion of that four-hour period.\nAdded by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES","CHAPTER 1351. HOME HEALTH SERVICES"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1351.htm#1351.007","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"20714480cd845f791a49cac6a770b77c2272d89eb21b4cc3b65ac22b327f40f9","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1351.006","next":"us-tx/tex.-insurance-code-1351.008"},"notice":"GroundRules: Original legal text. Not legal advice."}