Tex.
Ins. Code Section 1217.002
Applicability of Chapter
(a)
This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including an individual, group, blanket, or franchise insurance policy or insurance agreement, a group hospital service contract, or a small or large employer group contract or similar coverage document that is offered by:(1)
an insurance company;(2)
a group hospital service corporation operating under Chapter 842 (Group Hospital Service Corporations);(3)
a fraternal benefit society operating under Chapter 885 (Fraternal Benefit Societies);(4)
a stipulated premium company operating under Chapter 884 (Stipulated Premium Insurance Companies);(5)
a reciprocal exchange operating under Chapter 942 (Reciprocal and Interinsurance Exchanges);(6)
a health maintenance organization operating under Chapter 843 (Health Maintenance Organizations);(7)
a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements); or(8)
an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations).(b)
This chapter applies to group health coverage made available by a school district in accordance with Section 22.004 (Group Health Benefits for School Employees), Education Code.(c)
Notwithstanding any provision in 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) or any other law, this chapter applies to:(1)
a basic coverage plan under Chapter 1551 (Texas Employees Group Benefits Act);(2)
a basic plan under Chapter 1575 (Texas Public School Employees Group Benefits Program);(3)
a primary care coverage plan under Chapter 1579 (Texas School Employees Uniform Group Health Coverage); and(4)
basic coverage under Chapter 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System).(d)
Notwithstanding any other law, this chapter applies to coverage under:(1)
the child health plan program under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code, or the health benefits plan for children under Chapter 63 (Health Benefits Plan for Certain Children), Health and Safety Code; and(2)
a Medicaid managed care program operated under Chapter 533, Government Code, or a Medicaid program operated under Chapter 32 (Medical Assistance Program), Human Resources Code.(d)
Notwithstanding any other law, this chapter applies to coverage under:(1)
the child health plan program under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code, or the health benefits plan for children under Chapter 63 (Health Benefits Plan for Certain Children), Health and Safety Code; and(2)
a Medicaid managed care program operated under Chapter 540 (Medicaid Managed Care Program) or 540A (Medicaid Managed Transportation Services), Government Code, as applicable, or a Medicaid program operated under Chapter 32 (Medical Assistance Program), Human Resources Code.
Source:
Section 1217.002 — Applicability of Chapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1217.htm#1217.002 (accessed May 18, 2024).
