Texas Statutes
Subchapter A. Group Health Benefit Plan Coverage
Section 1355.004. Required Coverage for Serious Mental Illness

Sec. 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS. (a) A group health benefit plan:
(1) must provide coverage, based on medical necessity, for not less than the following treatments of serious mental illness in each calendar year:
(A) 45 days of inpatient treatment; and
(B) 60 visits for outpatient treatment, including group and individual outpatient treatment;
(2) may not include a lifetime limitation on the number of days of inpatient treatment or the number of visits for outpatient treatment covered under the plan; and
(3) must include the same amount limitations, deductibles, copayments, and coinsurance factors for serious mental illness as the plan includes for physical illness.
(b) A group health benefit plan issuer:
(1) may not count an outpatient visit for medication management against the number of outpatient visits required to be covered under Subsection (a)(1)(B); and
(2) must provide coverage for an outpatient visit described by Subsection (a)(1)(B) under the same terms as the coverage the issuer provides for an outpatient visit for the treatment of physical illness.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.

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