Tex.
Ins. Code Section 843.051
Applicability of Insurance and Group Hospital Service Corporation Laws
(a)
Except to the extent that the commissioner determines that the nature of health maintenance organizations, health care plans, or evidences of coverage renders a provision of the following laws clearly inappropriate, Subchapter A (Short Title), Chapter 542 (Processing and Settlement of Claims), Subchapters D and E, Chapter 544 (Prohibited Discrimination), and Chapters 541 (Unfair Methods of Competition and Unfair or Deceptive Acts or Practices), 543 (Prohibited Practices Related to Policy or Certificate of Membership), and 547 (False Advertising by Unauthorized Insurers) apply to:(1)
health maintenance organizations that offer basic, limited, and single health care coverages;(2)
basic, limited, and single health care plans; and(3)
evidences of coverage under basic, limited, and single health care plans.(b)
A health maintenance organization is subject to:(1)
Chapter 402 (Disclosure of Material Transactions);(2)
Chapter 827 (Withdrawal and Restriction Plans) and is an authorized insurer for purposes of that chapter; and(3)
Subchapter G (Continuation of Group Coverage), Chapter 1251 (Group and Blanket Health Insurance), and Section 1551.064 (Certain Group Health and Accident Policies or Contracts).(c)
Except as otherwise provided by this chapter or other law, insurance laws and group hospital service corporation laws do not apply to a health maintenance organization that holds a certificate of authority under this chapter. This subsection applies to an insurer or a group hospital service corporation only with respect to the health maintenance organization activities of the insurer or corporation.(d)
Activities permitted under other chapters of this code are not subject to this chapter.(e)
Except for Chapter 251 (General Provisions), as applicable to a third-party administrator, and Chapters 259 (Third-party Administrators), 4151 (Third-party Administrators), and 4201 (Utilization Review Agents), insurance laws and group hospital service corporation laws do not apply to a physician or provider. Notwithstanding this subsection, a physician or provider who conducts a utilization review during the ordinary course of treatment of patients under a joint or delegated review agreement with a health maintenance organization on services provided by the physician or provider is not required to obtain certification under Subchapter C (Certificate of Registration Required), Chapter 4201 (Utilization Review Agents).(f)
A health maintenance organization is subject to Chapter 823 (Insurance Holding Company Systems) as if the health maintenance organization were an insurer under that chapter.(g)
The merger of a health maintenance organization with another health maintenance organization is subject to Chapter 824 (Merger and Consolidation of Stock Insurance Corporations) as if the health maintenance organizations were insurance corporations under that chapter. The commissioner may adopt rules as necessary to implement this subsection in a way that reflects the nature of health maintenance organizations, health care plans, or evidences of coverage.
Source:
Section 843.051 — Applicability of Insurance and Group Hospital Service Corporation Laws, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.843.htm#843.051 (accessed Jun. 5, 2024).
