Exemption from State Mandates for High Deductible Health Plans

(a) No provision of the Insurance Code may be construed to prevent a health carrier or other entity issuing a health benefit plan from applying deductible or copayment requirements to benefits and services, including state-mandated health benefits and services, in order to qualify the health benefit plan as a high deductible health plan.

(b) Subsection (a) of this section does not apply to a preventive care benefit or service. Example: Insurance Code §§1367.053 and 1367.054 require a health benefit plan to cover certain childhood immunizations without making them subject to a deductible, copayment, or coinsurance requirement. While compliance with this Texas statute would ostensibly prevent a health benefit plan from qualifying as a high deductible health plan, since IRS Bulletin 2004-15 classifies the benefit as preventive care, the safe harbor of 29 U.S.C. §228 allows a high-deductible health plan to cover it on a first-dollar basis. Accordingly, compliance with §§1367.053 and 1367.054 does not prevent a health benefit plan from qualifying as a high deductible health plan, and Insurance Code §1653.002 thus would not except a health carrier issuing a high deductible health plan from compliance with the state mandate.

Source Note: The provisions of this §21.3904 adopted to be effective May 31, 2006, 31 TexReg 4439.