Tex.
Ins. Code Section 1222.0002
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 an individual or group evidence of coverage or similar coverage document that is issued by:(1)
an insurance company;(2)
a group hospital service corporation operating under Chapter 842 (Group Hospital Service Corporations);(3)
a health maintenance organization operating under Chapter 843 (Health Maintenance Organizations);(4)
an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations);(5)
a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements);(6)
a stipulated premium company operating under Chapter 884 (Stipulated Premium Insurance Companies);(7)
a fraternal benefit society operating under Chapter 885 (Fraternal Benefit Societies);(8)
a Lloyd’s plan operating under Chapter 941 (Lloyd’s Plan); or(9)
an exchange operating under Chapter 942 (Reciprocal and Interinsurance Exchanges).(b)
Notwithstanding any other law, this chapter applies to:(1)
a small employer health benefit plan subject to Chapter 1501 (Health Insurance Portability and Availability Act), including coverage provided through a health group cooperative under Subchapter B of that chapter;(2)
a standard health benefit plan issued under Chapter 1507 (Consumer Choice of Benefits Plans);(3)
a basic coverage plan under Chapter 1551 (Texas Employees Group Benefits Act);(4)
a basic plan under Chapter 1575 (Texas Public School Employees Group Benefits Program);(5)
a primary care coverage plan under Chapter 1579 (Texas School Employees Uniform Group Health Coverage);(6)
a plan providing basic coverage under Chapter 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System);(7)
health benefits provided by or through a church benefits board under Subchapter I (Definition), Chapter 22 (Nonprofit Corporations), Business Organizations Code;(8)
group health coverage made available by a school district in accordance with Section 22.004 (Group Health Benefits for School Employees), Education Code;(9)
the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;(10)
the child health plan program under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code;(11)
a regional or local health care program operated under Section 75.104 (Health Care Services), Health and Safety Code; and(12)
a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 (Professional Employer Organizations), Labor Code.(b)
Notwithstanding any other law, this chapter applies to:(1)
a small employer health benefit plan subject to Chapter 1501 (Health Insurance Portability and Availability Act), including coverage provided through a health group cooperative under Subchapter B of that chapter;(2)
a standard health benefit plan issued under Chapter 1507 (Consumer Choice of Benefits Plans);(3)
a basic coverage plan under Chapter 1551 (Texas Employees Group Benefits Act);(4)
a basic plan under Chapter 1575 (Texas Public School Employees Group Benefits Program);(5)
a primary care coverage plan under Chapter 1579 (Texas School Employees Uniform Group Health Coverage);(6)
a plan providing basic coverage under Chapter 1601 (Uniform Insurance Benefits Act for Employees of the University of Texas System and the Texas A&m University System);(7)
health benefits provided by or through a church benefits board under Subchapter I (Definition), Chapter 22 (Nonprofit Corporations), Business Organizations Code;(8)
group health coverage made available by a school district in accordance with Section 22.004 (Group Health Benefits for School Employees), Education Code;(9)
the state Medicaid program, including the Medicaid managed care program operated under Chapters 540 (Medicaid Managed Care Program) and 540A (Medicaid Managed Transportation Services), Government Code;(10)
the child health plan program under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code;(11)
a regional or local health care program operated under Section 75.104 (Health Care Services), Health and Safety Code; and(12)
a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 (Professional Employer Organizations), Labor Code.
Source:
Section 1222.0002 — Applicability of Chapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1222.htm#1222.0002 (accessed Jun. 5, 2024).
