Tex.
Ins. Code Section 1223.001
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 Lloyd’s plan operating under Chapter 941 (Lloyd’s Plan); or(8)
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)
alternative health benefit coverage offered by a subsidiary of the Texas Mutual Insurance Company under Subchapter M (Definition), Chapter 2054 (Texas Mutual Insurance Company);(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)
a regional or local health care program operated under Section 75.104 (Health Care Services), Health and Safety Code; and(10)
a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 (Professional Employer Organizations), Labor Code.(c)
This chapter does not apply to the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code, or the child health plan program operated under Chapter 62 (Child Health Plan for Certain Low-income Children), Health and Safety Code.
Source:
Section 1223.001 — Applicability of Chapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1223.htm#1223.001 (accessed Jun. 5, 2024).
