Tex.
Ins. Code Section 38.353
Applicability of Subchapter
(a)
This subchapter applies to the issuer of a group health benefit plan, including:(1)
an insurance company;(2)
a group hospital service corporation;(3)
a fraternal benefit society;(4)
a stipulated premium company;(5)
a reciprocal or interinsurance exchange; or(6)
a health maintenance organization.(b)
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, and except as provided by Subsection (e), 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).(c)
Except as provided by Subsection (d), this subchapter applies to a small employer health benefit plan provided under Chapter 1501 (Health Insurance Portability and Availability Act).(d)
This subchapter does not apply to:(1)
standard health benefit plans provided under Chapter 1507 (Consumer Choice of Benefits Plans);(2)
children’s health benefit plans provided under Chapter 1502 (Health Benefit Plans for Children);(3)
health care benefits provided under a workers’ compensation insurance policy;(4)
Medicaid managed care programs operated under Chapter 533, Government Code;(5)
Medicaid programs operated under Chapter 32 (Medical Assistance Program), Human Resources Code; or(6)
the state child health plan operated under Chapter 62 (Child Health Plan for Certain Low-income Children) or 63 (Health Benefits Plan for Certain Children), Health and Safety Code.(d)
This subchapter does not apply to:(1)
standard health benefit plans provided under Chapter 1507 (Consumer Choice of Benefits Plans);(2)
children’s health benefit plans provided under Chapter 1502 (Health Benefit Plans for Children);(3)
health care benefits provided under a workers’ compensation insurance policy;(4)
Medicaid managed care programs operated under Chapter 540 (Medicaid Managed Care Program) or 540A (Medicaid Managed Transportation Services), Government Code, as applicable;(5)
Medicaid programs operated under Chapter 32 (Medical Assistance Program), Human Resources Code; or(6)
the state child health plan operated under Chapter 62 (Child Health Plan for Certain Low-income Children) or 63 (Health Benefits Plan for Certain Children), Health and Safety Code.(e)
The commissioner by rule may exclude a type of health benefit plan from the requirements of this subchapter if the commissioner finds that data collected in relation to the health benefit plan would not be relevant to accomplishing the purposes of this subchapter.
Source:
Section 38.353 — Applicability of Subchapter, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.38.htm#38.353 (accessed May 11, 2024).
