Source-of-Injury Exclusions

(a) No denial of benefits. If a health benefit plan generally provides benefits for a type of injury, the plan may not deny benefits otherwise provided for treatment of the injury if the injury results from an act of domestic violence or a medical condition (including both physical and mental health conditions). This rule applies in the case of an injury resulting from a medical condition even if the condition is not diagnosed before the injury.

(b) Example. The requirements of subsection (a) of this section are illustrated by the example in figure 28 TAC §21.2414(b).

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Source Note: The provisions of this §21.2414 adopted to be effective September 7, 2021, 46 TexReg 5571.