Tex.
Ins. Code Section 1367.251
Applicability of Subchapter
(a)
This subchapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 (Health Insurance Portability and Availability Act) or coverage provided through 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 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 Lloyd’s plan operating under Chapter 941 (Lloyd’s Plan);(5)
a stipulated premium insurance company operating under Chapter 884 (Stipulated Premium Insurance Companies);(6)
a reciprocal exchange operating under Chapter 942 (Reciprocal and Interinsurance Exchanges);(7)
a health maintenance organization operating under Chapter 843 (Health Maintenance Organizations);(8)
a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements); or(9)
an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations).(b)
This subchapter 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, agreement, or contract is delivered, issued for delivery, or renewed within or outside this state.(c)
This subchapter applies to a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 (Professional Employer Organizations), Labor Code.(d)
Notwithstanding Section 22.409 (Insurance Code Not Applicable), Business Organizations Code, or any other law, this subchapter applies to health benefits provided by or through a church benefits board under Subchapter I (Definition), Chapter 22 (Nonprofit Corporations), Business Organizations Code.(e)
Notwithstanding Section 75.104 (Health Care Services), Health and Safety Code, or any other law, this subchapter applies to a regional or local health care program operated under that section.(f)
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 subchapter.(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 subchapter 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).
Source:
Section 1367.251 — Applicability of Subchapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1367.htm#1367.251 (accessed Jun. 5, 2024).
