Tex.
Ins. Code Section 1356.002
Applicability of Chapter
(a)
This chapter applies to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 (Health Insurance Portability and Availability Act) or coverage that is provided by a health group cooperative under Subchapter B of that chapter, 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 offered 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)
This chapter applies to coverage under a group health benefit plan described by Subsection (a) provided to a resident of this state, regardless of whether the group policy or contract is delivered, issued for delivery, or renewed within or outside this state.(c)
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)(b), Education Code.(d)
This chapter applies to a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 (Professional Employer Organizations), Labor Code.(e)
Notwithstanding Section 22.409 (Insurance Code Not Applicable), Business Organizations Code, or any other law, this chapter applies to a church benefits board established under Chapter 22 (Nonprofit Corporations), Business Organizations Code.(f)
Notwithstanding Section 75.104 (Health Care Services), Health and Safety Code, or any other law, this chapter applies to a regional or local health care program established under Chapter 75 (Regional or Local Health Care Programs for Employees of Small Employers), Health and Safety Code.(g)
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).(h)
Notwithstanding any other law, a standard health benefit plan provided under Chapter 1507 (Consumer Choice of Benefits Plans) must provide the coverage required by this chapter.(i)
To the extent allowed by federal law, this chapter applies to:(1)
the state Medicaid program operated under Chapter 32 (Medical Assistance Program), Human Resources Code; and(2)
a Medicaid managed care program operated under Chapter 533, Government Code.(i)
To the extent allowed by federal law, this chapter applies to:(1)
the state Medicaid program operated under Chapter 32 (Medical Assistance Program), Human Resources 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.
Source:
Section 1356.002 — Applicability of Chapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1356.htm#1356.002 (accessed Jun. 5, 2024).
