Section 1369.602 - Applicability Of Subchapter(a) This subchapter applies only to a health benefit plan that provides benefits for medical or surgical expenses 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 offered 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 subchapter 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) health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code; (4) group health coverage made available by a school district in accordance with Section 22.004, Education Code; (5) a regional or local health care program operated under Section 75.104, Health and Safety Code; and (6) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code. (c) This subchapter does not apply to an issuer or provider of health benefits under or a pharmacy benefit manager administering pharmacy benefits under a workers' compensation insurance policy or other form of providing medical benefits under Title 5, Labor Code. Tex. Ins. Code § 1369.602
Amended by Acts 2023, Texas Acts of the 88th Leg.- Regular Session, ch. 768,Sec. 24.001, eff. 9/1/2023.Added by Acts 2021, Texas Acts of the 87th Leg. - Regular Session, ch. 142,Sec. 1, eff. 9/1/2021.