Tex.
Ins. Code Section 1453.001
Definitions
(1)
“Health care provider” means:(A)
a hospital, emergency clinic, outpatient clinic, or other facility providing health care services; or(B)
an individual who is licensed in this state to provide health care services.(2)
“Managed care entity” means:(A)
a health maintenance organization;(B)
a preferred provider benefit plan issuer;(C)
an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations); or(D)
another entity that offers a managed care plan, including:(i)
an insurance company;(ii)
a group hospital service corporation operating under Chapter 842 (Group Hospital Service Corporations);(iii)
a fraternal benefit society operating under Chapter 885 (Fraternal Benefit Societies);(iv)
a stipulated premium company operating under Chapter 884 (Stipulated Premium Insurance Companies);(v)
a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements); and(vi)
an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis.(3)
“Managed care plan” means a health benefit plan:(A)
under which health care services are provided through contracts with health care providers to individuals enrolled in or insured under the plan; and(B)
that provides financial incentives to individuals enrolled in or insured under the plan to use health care providers participating in the plan and procedures covered by the plan.
Source:
Section 1453.001 — Definitions, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1453.htm#1453.001 (accessed Nov. 25, 2023).
