Section 21.3002 - Definitions; Pharmacy Identification CardsThe following words and terms, when used in this division, have the following meanings, unless the context clearly indicates otherwise:
(1) Administrator--As defined in Insurance Code § 4151.001(1), for plans subject to Insurance Code Chapter 1369, Subchapter D .(2) Drug--As defined in the Texas Pharmacy Act, Occupations Code § 551.003.(3) Drug formulary--A list of drugs for which a health benefit plan provides coverage, approves payment, or encourages or offers incentives for physicians or other health care providers to prescribe.(4) Effective date--The date that the health benefit plan's current prescription drug benefit levels became effective, or the date the subscriber's coverage first became effective, whichever is later.(5) Enrollee--A person covered by a health benefit plan.(6) Enrollee identification card--A printed card issued to enrollees of a health benefit plan that includes all necessary information to allow an enrollee to access all coverage under the health benefit plan.(7) Health benefit plan--As described in Insurance Code § 1369.151, including a health benefit plan providing coverage for pharmacy benefits only, but not those described in Insurance Code § 1369.152. This definition includes the term, "plan," as defined in Insurance Code § 4151.001(4), but does not include a self-funded employee welfare benefit plan exempt from state regulation under ERISA, 29 U.S.C. § 1002(1)(A).(8) Identification code--Any unique code used by an issuer of a health benefit plan, administrator, or pharmacy benefit manager that identifies and differentiates among enrollees.(9) Issuer--Those entities described in Insurance Code § 1369.151, but not those excluded by Insurance Code § 1369.152.(10) Pharmacy benefit manager--As defined in Insurance Code § 4151.151, but does not include a pharmacy benefit manager for a self-funded employee welfare benefit plan exempt from state regulation under ERISA, 29 U.S.C. § 1002(1)(A).(11) Pharmacy benefits--Coverage in a health benefit plan for prescription drugs that are ordinarily and customarily dispensed by a pharmacy or pharmacist licensed under the Texas Pharmacy Act, Occupations Code § 551.001, et seq.(12) Standard identification card--A printed card containing the written information required by § 21.3003(b) of this title (relating to Standard Identification Cards).(13) Subscriber--The individual who is the contract holder and who is responsible for payment of premiums to the issuer of an individual health benefit plan; or the individual who is the certificate holder and whose employment or membership status, except for family dependency, is the basis for eligibility for enrollment in a health benefit plan.28 Tex. Admin. Code § 21.3002
The provisions of this §21.3002 adopted to be effective December 20, 2000, 25 TexReg 12441; Amended by Texas Register, Volume 41, Number 33, August 12, 2016, TexReg 6042, eff. 8/18/2016