Tex. Ins. Code Section 1213.001
Definition of Health Benefit Plan


In this chapter, “health benefit plan” means a plan that provides benefits for medical, surgical, or other treatment expenses incurred as a result of a health condition, a mental health condition, an accident, sickness, or substance abuse, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or an individual or group evidence of coverage or similar coverage document that is offered by:


an insurance company;


a group hospital service corporation operating under Chapter 842 (Group Hospital Service Corporations);


a fraternal benefit society operating under Chapter 885 (Fraternal Benefit Societies);


a stipulated premium insurance company operating under Chapter 884 (Stipulated Premium Insurance Companies);


a Lloyd’s plan operating under Chapter 941 (Lloyd’s Plan);


an exchange operating under Chapter 942 (Reciprocal and Interinsurance Exchanges);


a health maintenance organization operating under Chapter 843 (Health Maintenance Organizations);


a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements); or


an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations).


The term includes:


a small employer health benefit plan written under Chapter 1501 (Health Insurance Portability and Availability Act); and


a health benefit plan offered under Chapter 1551 (Texas Employees Group Benefits Act), 1575 (Texas Public School Employees Group Benefits Program), 1579 (Texas School Employees Uniform Group Health Coverage), or 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System).
Added by Acts 2005, 79th Leg., Ch. 728 (H.B. 2018), Sec. 11.029(a), eff. September 1, 2005.

Source: Section 1213.001 — Definition of Health Benefit Plan, https://statutes.­capitol.­texas.­gov/Docs/IN/htm/IN.­1213.­htm#1213.­001 (accessed Jun. 5, 2024).

Jun. 5, 2024

§ 1213.001’s source at texas​.gov