# Tex. Insurance Code § 1355.004: REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS

> Texas · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.004

## Section

- **Citation:** Tex. Insurance Code § 1355.004
- **Heading:** REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS
- **Jurisdiction:** Texas
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** TX Code / Code in / Chapter 1355 / Section 1355.004

## Text

(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.

## Nearby sections

- [Tex. Insurance Code § 1355.001 § 1355.001. DEFINITIONS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.001.md)
- [Tex. Insurance Code § 1355.002 § 1355.002. APPLICABILITY OF SUBCHAPTER.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.002.md)
- [Tex. Insurance Code § 1355.003 § 1355.003. EXCEPTION.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.003.md)
- [Tex. Insurance Code § 1355.004 § 1355.004. REQUIRED COVERAGE FOR SERIOUS MENTAL ILLNESS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.004.md)
- [Tex. Insurance Code § 1355.005 § 1355.005. MANAGED CARE PLAN AUTHORIZED.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.005.md)
- [Tex. Insurance Code § 1355.006 § 1355.006. COVERAGE FOR CERTAIN CONDITIONS RELATED TO CONTROLLED SUBSTANCE OR MARIHUANA NOT REQUIRED.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.006.md)
- [Tex. Insurance Code § 1355.007 § 1355.007. SMALL EMPLOYER COVERAGE.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.007.md)
- [Tex. Insurance Code § 1355.015 § 1355.015. REQUIRED COVERAGE FOR CERTAIN ENROLLEES.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.015.md)
- [Tex. Insurance Code § 1355.051 § 1355.051. DEFINITIONS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.051.md)
- [Tex. Insurance Code § 1355.052 § 1355.052. APPLICABILITY OF SUBCHAPTER.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.052.md)
- [Tex. Insurance Code § 1355.053 § 1355.053. REQUIRED COVERAGE FOR CERTAIN ILLNESSES AND DISORDERS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.053.md)
- [Tex. Insurance Code § 1355.054 § 1355.054. CONDITIONS FOR COVERAGE.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.054.md)
- [Tex. Insurance Code § 1355.055 § 1355.055. DETERMINATIONS FOR TREATMENT IN A RESIDENTIAL TREATMENT CENTER FOR CHILDREN AND ADOLESCENTS.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.055.md)
- [Tex. Insurance Code § 1355.056 § 1355.056. DETERMINATIONS FOR TREATMENT BY A CRISIS STABILIZATION UNIT.](https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.056.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_TX_Cin_C1355_S1355.004. Check the current official text before relying on it. Not legal advice.