Sec. 544.152. APPLICABILITY OF SUBCHAPTER. (a) This subchapter applies only to:
(1) a life insurer that delivers, issues for delivery, or renews a life insurance contract or policy in this state, including a group contract, policy, or certificate of life insurance; and
(2) a health benefit plan issuer that provides benefits for medical or surgical expenses incurred as a result of a health condition, accident, or sickness, including:
(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 benefit plan issuer under Chapter 1501;
(F) a health maintenance organization operating under Chapter 843;
(G) an employer under a multiple employer welfare arrangement as defined by Section 3, Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1002), or an analogous benefit arrangement, to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.);
(H) an issuer of a Medicare supplemental policy as defined by Section 1882(g)(1), Social Security Act (42 U.S.C. Section 1395ss); and
(I) an approved nonprofit health corporation that holds a certificate of authority issued under Chapter 844.
(b) This subchapter does not apply to the issuer of:
(1) a health benefit plan that provides coverage:
(A) only for a specified disease;
(B) only for accidental death or dismemberment;
(C) for wages or payments in lieu of wages for a period during which an employee is absent from work because of sickness or injury;
(D) as a supplement to liability insurance;
(E) only for limited benefits; or
(F) only for dental or vision care;
(2) hospital confinement indemnity coverage;
(3) a credit insurance policy;
(4) workers' compensation insurance coverage;
(5) medical payment insurance coverage provided under a motor vehicle insurance policy; or
(6) a long-term care policy, including a nursing home fixed indemnity policy, unless the commissioner determines that the policy provides benefit coverage so comprehensive that the policy is a health benefit plan as described by Subsection (a)(2).
Added by Acts 2003, 78th Leg., ch. 1274, Sec. 2, eff. April 1, 2005.
Section: Previous 544.052 544.053 544.054 544.101 544.102 544.103 544.151 544.152 544.153 544.154 544.155 544.156 544.157 544.158 544.201 NextLast modified: September 28, 2016