Section 1456.002 - [Effective Until 4/1/2025] Applicability of Chapter(a) This chapter applies to any health benefit plan that: (1) 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 that is offered by: (A) an insurance company;(B) a group hospital service corporation operating under Chapter 842;(C) a fraternal benefit society operating under Chapter 885;(D) a stipulated premium company operating under Chapter 884;(E) a health maintenance organization operating under Chapter 843;(F) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;(G) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or(H) an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis; or(2) provides health and accident coverage through a risk pool created under Chapter 172, Local Government Code, notwithstanding Section 172.014, Local Government Code, or any other law.(b) This chapter applies to a person to whom a health benefit plan contracts to: (1) process or pay claims;(2) obtain the services of physicians or other providers to provide health care services to enrollees; or(3) issue verifications or preauthorizations.(c) This chapter does not apply to: (1) Medicaid managed care programs operated under Chapter 533, Government Code;(2) Medicaid programs operated under Chapter 32, Human Resources Code; or(3) the state child health plan operated under Chapter 62 or 63, Health and Safety Code.Tex. Ins. Code § 1456.002
Added by Acts 2007, 80th Leg., R.S., Ch. 997, Sec. 11, eff. 9/1/2007.This section is set out more than once due to postponed, multiple, or conflicting amendments.