Sec. 1456.002. 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.
Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731), Sec. 11, eff. September 1, 2007.
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