Sec. 1205.001. APPLICABILITY OF CHAPTER. This chapter applies only to a health benefit plan that:
(1) provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:
(A) 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:
(i) an insurance company;
(ii) a group hospital service corporation operating under Chapter 842;
(iii) a fraternal benefit society operating under Chapter 885;
(iv) a stipulated premium company operating under Chapter 884; or
(v) a health maintenance organization operating under Chapter 843; and
(B) to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.), a health benefit plan that is offered by:
(i) a multiple employer welfare arrangement as defined by Section 3 of that Act and operating under Chapter 846; or
(ii) an analogous benefit arrangement;
(2) is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or
(3) is offered by any other entity that:
(A) is not authorized under this code or another insurance law of this state; and
(B) contracts directly for health care services on a risk-sharing basis, including a capitation basis.
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.
Section: 1205.001 1205.002 1205.003 NextLast modified: September 28, 2016