Texas Health and Safety Code - HEALTH & SAFETY § 311.006. Direct Payment to Hospital

(1) "Enrollee" means an individual who is enrolled in a health benefit plan or otherwise entitled to coverage under a health benefit plan.

(2) "Health benefit plan" means any individual or group arrangement with a public or private entity under which the entity will pay for, reimburse expenses for, or otherwise contract with a health care provider for the provision of health care services, supplies, or devices to a patient.  The term includes an arrangement with:

(3) "Health care service" means a service to diagnose, prevent, alleviate, cure, or heal a human illness or injury that is provided to an individual by a physician or other health care provider.

(4) "Hospital" means a public or private institution licensed under Chapter 241. The term does not include an ambulatory surgical center licensed under Chapter 243.

(1) not more than 25 percent greater than the amounts generally billed, as defined by 26 C.F.R. Section 1.501(r)-1, for a health care service;  or

(2) not more than 50 percent greater than the lowest contracted rate for a health care service that the hospital has agreed to accept as payment in full as a contracted, preferred, or participating provider of a health benefit plan other than: