Tex.
Ins. Code Section 1369.602
Applicability of Subchapter
(a)
This subchapter 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 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)
Notwithstanding any other law, this subchapter 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)
health benefits provided by or through a church benefits board under Subchapter I (Definition), Chapter 22 (Nonprofit Corporations), Business Organizations Code;(4)
group health coverage made available by a school district in accordance with Section 22.004 (Group Health Benefits for School Employees), Education Code;(5)
a regional or local health care program operated under Section 75.104 (Health Care Services), Health and Safety Code; and(6)
a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91 (Professional Employer Organizations), Labor Code.(c)
This subchapter does not apply to an issuer or provider of health benefits under or a pharmacy benefit manager administering pharmacy benefits under a workers’ compensation insurance policy or other form of providing medical benefits under Title 5, Labor Code.
Source:
Section 1369.602 — Applicability of Subchapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1369.htm#1369.602 (accessed Jun. 5, 2024).
