Texas Administrative Code
Title 28 - INSURANCE
Part 1 - TEXAS DEPARTMENT OF INSURANCE
Chapter 3 - LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
Subchapter S - MINIMUM STANDARDS AND BENEFITS AND READABILITY FOR INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES
Section 3.3071 - Minimum Standards for Basic Hospital Expense Coverage

Universal Citation: 28 TX Admin Code § 3.3071

Current through Reg. 50, No. 13; March 28, 2025

(a) "Basic hospital expense insurance" is a policy of accident and health insurance which provides coverage for a period of not less than 31 days during any one period of confinement for each person insured under the policy for the expense incurred for necessary treatment and services rendered as a result of an injury or sickness for at least the following:

(1) daily hospital room and board in an amount not less than:

(A) 80% of the charges for semi-private room accommodations; or

(B) $30 per day;

(2) miscellaneous hospital services for expenses incurred for the charges made by the hospital for services and supplies which are customarily rendered by the hospital and provided for use only during the period of continuous hospital confinement in an amount not less than either 80% of the charges incurred up to at least $1,000 or 10 times the daily hospital room and board benefit rate;

(3) hospital outpatient services:

(A) hospital services on the day surgery is performed in an amount not less than $50; and

(B) hospital services rendered within 72 hours after accidental injury, in an amount not less than $50; and

(C) x-ray and laboratory tests to the extent that benefits for such services would have been provided, in an amount not less than $100, if rendered to an inpatient of the hospital;

(4) benefits provided under paragraphs (1) and (2) of this section may be provided subject to a combined deductible amount not in excess of $100 per period of confinement;

(5) if hospital confinement maternity benefits are included within the scope of policy coverage then the amount of the minimum benefits for each covered pregnancy shall be the actual expenses incurred according to the policy terms up to an amount that is equal to 10 times the minimum daily hospital room and board benefit.

(b) Basic hospital expense insurance must be guaranteed renewable in accordance with § 3.3020 of this title (relating to Policy Definition of Guaranteed Renewable and Limited Guarantee of Renewability) and § 3.3038 of this title (relating to Mandatory Guaranteed Renewability Provisions for Individual Hospital, Medical or Surgical Coverage; Exceptions) of this subchapter, unless such insurance constitutes short-term limited duration coverage, as defined in § 3.3002(b)(18) of this title (relating to Definitions).

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