Tex.
Ins. Code Section 1661.001
Definitions
(1)
“Health benefit plan” means a 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 that is offered by:(A)
an insurance company;(B)
a group hospital service corporation operating under Chapter 842 (Group Hospital Service Corporations);(C)
a fraternal benefit society operating under Chapter 885 (Fraternal Benefit Societies);(D)
a stipulated premium company operating under Chapter 884 (Stipulated Premium Insurance Companies);(E)
a Lloyd’s plan operating under Chapter 941 (Lloyd’s Plan);(F)
an exchange operating under Chapter 942 (Reciprocal and Interinsurance Exchanges);(G)
a health maintenance organization operating under Chapter 843 (Health Maintenance Organizations);(H)
a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 (Multiple Employer Welfare Arrangements);(I)
an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 (Certification of Certain Nonprofit Health Corporations); or(J)
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.(2)
“Health benefit plan issuer” means an entity authorized to issue a health benefit plan in this state.(3)
“Health care provider” means:(A)
an individual who is licensed, certified, or otherwise authorized to provide health care services; or(B)
a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.(4)
“Participating provider” means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.
Source:
Section 1661.001 — Definitions, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.1661.htm#1661.001 (accessed Jun. 5, 2024).
