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Texas Insurance Code - INS § 1373.002. Applicability of Chapter

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) This chapter applies only to a health benefit plan that provides benefits for medical or surgical expenses or pharmacy benefits 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 or similar coverage document that is issued by:

(1) an insurance company;

(2) a group hospital service corporation operating under Chapter 842;

(3) a health maintenance organization operating under Chapter 843;

(4) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;

(5) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;

(6) a stipulated premium company operating under Chapter 884;

(7) a fraternal benefit society operating under Chapter 885;

(8) a Lloyd's plan operating under Chapter 941;  or

(9) an exchange operating under Chapter 942.

(b) Notwithstanding any other law, this chapter applies to:

(1) a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;

(2) a standard health benefit plan issued under Chapter 1507;

(3) a basic coverage plan under Chapter 1551;

(4) a basic plan under Chapter 1575;

(5) a primary care coverage plan under Chapter 1579;

(6) a plan providing basic coverage under Chapter 1601;

(7) nonprofit agricultural organization health benefits offered by a nonprofit agricultural organization under Chapter 1682;

(8) alternative health benefit coverage offered by a subsidiary of the Texas Mutual Insurance Company under Subchapter M, Chapter 2054;

(9) group health coverage made available by a school district in accordance with Section 22.004, Education Code;

(10) the state Medicaid program, including the Medicaid managed care program operated under Chapter 540, Government Code;

(11) the child health plan program under Chapter 62, Health and Safety Code;

(12) a regional or local health care program operated under Section 75.104, Health and Safety Code;

(13) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code;

(14) county employee group health benefits provided under Chapter 157, Local Government Code;  and

(15) health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code.

(c) This chapter applies to coverage under a group health benefit plan provided to a resident of this state regardless of whether the group policy, agreement, or contract is delivered, issued for delivery, or renewed in this state.

(d) This chapter does not apply to a self-funded health benefit plan as defined by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.).

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Cite this article: FindLaw.com - Texas Insurance Code - INS § 1373.002. Applicability of Chapter - last updated January 01, 2024 | https://codes.findlaw.com/tx/insurance-code/ins-sect-1373-002/

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