Tex.
Ins. Code Section 847.003
Definitions
(1)
“Commission” means the Health and Human Services Commission.(2)
“Health benefit plan” means an individual, group, blanket, or franchise insurance policy, a certificate issued under a group policy, a group hospital service contract, or an individual or group subscriber contract or evidence of coverage issued by a health maintenance organization that provides benefits for health care services. The term does not include:(A)
accident-only or disability income insurance coverage or a combination of accident-only and disability income insurance coverage;(B)
credit-only insurance coverage;(C)
disability insurance coverage;(D)
Medicare services under a federal contract;(E)
Medicare supplement and Medicare Select benefit plans regulated in accordance with federal law;(F)
long-term care coverage or benefits, nursing home care coverage or benefits, home health care coverage or benefits, community-based care coverage or benefits, or any combination of those coverages or benefits;(G)
workers’ compensation insurance coverage or similar insurance coverage;(H)
coverage provided through a jointly managed trust authorized under 29 U.S.C. Section 141 et seq. that contains a plan of benefits for employees that is negotiated in a collective bargaining agreement governing wages, hours, and working conditions of the employees that is authorized under 29 U.S.C. Section 157;(I)
hospital indemnity or other fixed indemnity insurance coverage;(J)
reinsurance contracts issued on a stop-loss, quota-share, or similar basis;(K)
short-term major medical contracts;(L)
liability insurance coverage, including general liability insurance coverage and automobile liability insurance coverage, and coverage issued as a supplement to liability insurance coverage, including automobile medical payment insurance coverage;(M)
coverage for on-site medical clinics;(N)
coverage that provides other limited benefits specified by federal regulations;(O)
coverage that provides limited scope dental or vision benefits; or(P)
other coverage that:(i)
is similar to the coverage described by this subdivision under which benefits for medical care are secondary or incidental to other coverage benefits; and(ii)
is specified by federal regulations.(3)
“National accreditation organization” means:(A)
the Accreditation Association for Ambulatory Health Care;(B)
the Joint Commission on Accreditation of Healthcare Organizations;(C)
the National Committee for Quality Assurance;(D)
the American Accreditation HealthCare Commission (“URAC”); or(E)
any other national accreditation entity recognized by rules jointly adopted by the commissioner of insurance and the executive commissioner of the commission.
Source:
Section 847.003 — Definitions, https://statutes.capitol.texas.gov/Docs/IN/htm/IN.847.htm#847.003
(accessed May 18, 2024).