Tex.
Ins. Code Section 1452.101
Definitions
(1)
“Applicant physician” means a physician applying for expedited credentialing under this subchapter.(2)
“Enrollee” means an individual who is eligible to receive health care services under a managed care plan.(3)
“Health care provider” means:(A)
an individual who is licensed, certified, or otherwise authorized to provide health care services in this state; or(B)
a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.(4)
“Managed care plan” means a health benefit plan under which health care services are provided to enrollees through contracts with health care providers and that requires enrollees to use participating providers or that provides a different level of coverage for enrollees who use participating providers. The term includes a health benefit plan issued by:(A)
a health maintenance organization;(B)
a preferred provider benefit plan issuer; or(C)
any other entity that issues a health benefit plan, including an insurance company.(5)
“Medical group” means:(A)
a single legal entity owned by two or more physicians;(B)
a professional association composed of licensed physicians;(C)
any other business entity composed of licensed physicians as permitted under Subchapter B (Authority to Form Certain Jointly Owned Entities), Chapter 162 (Regulation of Practice of Medicine), Occupations Code; or(D)
two or more physicians on the medical staff of, or teaching at, a medical school or medical and dental unit, as defined or described by Section 61.003 (Definitions), 61.501 (Definitions), or 74.601 (Use and Control), Education Code.(6)
“Participating provider” means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.
Source:
Section 1452.101 — Definitions, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1452.htm#1452.101 (accessed Jun. 5, 2024).
