Does Health Insurance Cover Injuries Related to Alcohol Consumption?
It depends on your state and policy. Some states let insurers deny claims caused by intoxication under an old model law. Texas repealed that provision for individual accident and health policies issued or renewed on or after Jan. 1, 2014. Read your policy and ask your state insurance department.
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A Texas House Bill 3105 analysis describes a provision, Insurance Code section 1201.227, that allowed an insurer to refuse a claim for a loss sustained as a consequence of the insured being intoxicated. The sponsor’s statement says the National Association of Insurance Commissioners (NAIC) changed its position and now recommends repealing such provisions.
What Texas changed
The bill repealed that section. The repeal applies to individual accident and health policies delivered, issued or renewed on or after January 1, 2014. Older policies stay under the prior law. The stated goal was to encourage screening, brief intervention and referral to treatment for people showing signs of alcohol or drug problems in emergency rooms.
What this does not tell you
This is one state. We did not read other states’ laws, so we cannot say how yours works. Other policy types, such as disability or accident-only plans, can have their own terms.
How to check
- Search your policy for words such as “intoxication” or “alcohol” in the exclusions section.
- Ask your insurer in writing whether an injury claim would be affected.
- Contact your state insurance department.
This is general information, not legal or insurance advice.
People also ask
Can health insurance deny a claim because I was drunk?
Some states allowed it under an old model law. Texas repealed its version for individual policies issued or renewed on or after Jan. 1, 2014. Check your state and policy.
Who can I ask about my coverage?
Your insurer in writing and your state insurance department.
Did insurance regulators change their view on these exclusions?
The Texas bill sponsor's statement says the NAIC now recommends repealing such provisions.
Sources
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