{"data":{"id":"us-tx/tex.-insurance-code-1425.052","jurisdiction":"us-tx","citation":"Tex. Insurance Code § 1425.052","heading":"EXEMPTION FROM SUBTITLE FOR BENEFITS REQUIRING DEFRAYAL.","body":"(a) A provision of this subtitle that is enacted on or after January 1, 2012, does not apply to a qualified health plan if a determination is made under 45 C.F.R. Section 155.170 that:\n(1) the provision requires the qualified health plan to offer benefits in addition to the essential health benefits required under 42 U.S.C. Section 18022(b); and\n(2) this state must make payments to defray the cost of the additional benefits mandated by the provision.\n(b) If a determination described by Subsection (a) is made as to a qualified health plan, the provision to which the determination relates does not apply to a non-qualified health plan if the non-qualified health plan is offered in the same market as the qualified health plan.\nAdded by Acts 2021, 87th Leg., R.S., Ch. 890 (S.B. 2016), Sec. 3, eff. June 16, 2021.","path":["INSURANCE CODE","TITLE 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES","SUBTITLE E. BENEFITS PAYABLE UNDER HEALTH COVERAGES","CHAPTER 1425. APPLICATION OF SUBTITLE TO CERTAIN COVERAGE","SUBCHAPTER B. BENEFITS REQUIRING DEFRAYAL"],"source_url":"https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1425.htm#1425.052","current_through":"89th 2nd Called Legislative Session, 2025","vintage":"","retrieved_at":"2026-08-27T01:47:21Z","sha256":"bd8611f198874747abca87c581bc4a89d1b3838e7ebf88779a4104f319348fbd","source_id":"us-tx","stale":false,"prev":"us-tx/tex.-insurance-code-1425.051","next":"us-tx/tex.-insurance-code-1451.001"},"notice":"GroundRules: Original legal text. Not legal advice."}