Tex.
Ins. Code Section 1273.001
Definitions
(1)
“Blended contract” means a single document, including a single contract policy, certificate, or evidence of coverage, that provides a combination of indemnity and health maintenance organization benefits.(2)
“Health maintenance organization” has the meaning assigned by Section 843.002 (Definitions).(3)
“Insurer” means an insurance company, association, or organization authorized to engage in business in this state under Chapter 841 (Life, Health, or Accident Insurance Companies), 842 (Group Hospital Service Corporations), 861 (General Casualty Companies), 881 (Statewide Mutual Assessment Companies), 882 (Mutual Life Insurance Companies), 883 (Mutual Insurance Companies Other than Mutual Life Insurance Companies), 884 (Stipulated Premium Insurance Companies), 885 (Fraternal Benefit Societies), 886 (Local Mutual Aid Associations), 887 (Provisions Applicable to Certain Mutual Assessment Companies), 888 (Burial Associations), 941 (Lloyd’s Plan), 942 (Reciprocal and Interinsurance Exchanges), or 982 (Foreign and Alien Insurance Companies).(4)
“Point-of-service plan” means an arrangement under which:(A)
an enrollee chooses to obtain benefits or services through:(i)
a health maintenance organization delivery network, including a limited provider network; or(ii)
a non-network delivery system outside the health maintenance organization delivery network, including an exclusive provider benefit plan under Chapter 1301 (Preferred Provider Benefit Plans) or a limited provider network, that is administered under an indemnity benefit arrangement for the cost of health care services; or(B)
indemnity benefits for the cost of health care services are provided by an insurer or group hospital service corporation in conjunction with network benefits arranged or provided by a health maintenance organization.
Source:
Section 1273.001 — Definitions, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1273.htm#1273.001 (accessed May 18, 2024).
