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TITLE 28INSURANCE
PART 1TEXAS DEPARTMENT OF INSURANCE
CHAPTER 3LIFE, ACCIDENT, AND HEALTH INSURANCE AND ANNUITIES
SUBCHAPTER SMINIMUM STANDARDS AND BENEFITS AND READABILITY FOR INDIVIDUAL ACCIDENT AND HEALTH INSURANCE POLICIES
RULE §3.3006Policy Definition of Hospital

The term "hospital" may be defined in relation to its status, facilities, and available services. The definition may not stipulate as a condition that a hospital be incorporated or that it be recognized by any accrediting organizations.

  (1) Except as provided in these sections, the definition of the term "hospital" may not be more restrictive than one requiring that the facility:

    (A) be licensed as a hospital and operated pursuant to law; and

    (B) be primarily engaged in providing or operating (either on its premises or in facilities available to the hospital on a contractual prearranged basis and under the supervision of a staff of one or more duly licensed physicians), medical, diagnostic, and major surgery facilities for the medical care and treatment of sick or injured persons on an inpatient basis for which a charge is made; and

    (C) provide 24-hour nursing service by or under the supervision of a registered graduate professional nurse (RN); and

    (D) be an institution which maintains and operates a minimum of five beds; and

    (E) have x-ray and laboratory facilities either on the premises or available on a contractual prearranged basis; and

    (F) maintain permanent medical history records.

  (2) Hospitals which meet the following standards must be specifically recognized in policies which do not exclude by name the disease alcoholism:

    (A) facilities which are accredited by the Joint Commission on Accreditation of Hospitals; and

    (B) facilities which offer medical, therapeutic, and psychiatric care for the treatment of alcoholism.

  (3) The definition of the term "hospital" may exclude, except where prohibited by law and subject to the requirement of §3.3040(d) of this title (relating to Prohibited Policy Provisions), any:

    (A) military or veteran's hospital or soldier's home or any hospital contracted for or operated by the federal government or any agency thereof for the treatment of members or ex-members of the armed forces; or

    (B) convalescent homes, convalescent facilities, rest facilities, or nursing facilities; or

    (C) home or facilities primarily for the aged, drug addicts, alcoholics, those primarily affording custodial care, educational care or those primarily affording care for mental and nervous disorders.


Source Note: The provisions of this §3.3006 adopted to be effective January 26, 1977, 2 TexReg 159.

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