Sec. 843.051. APPLICABILITY OF INSURANCE AND GROUP HOSPITAL SERVICE CORPORATION LAWS. (a) Except to the extent that the commissioner determines that the nature of health maintenance organizations, health care plans, or evidences of coverage renders a provision of the following laws clearly inappropriate, Subchapter A, Chapter 542, Subchapters D and E, Chapter 544, and Chapters 541, 543, and 547 apply to:
(1) health maintenance organizations that offer basic, limited, and single health care coverages;
(2) basic, limited, and single health care plans; and
(3) evidences of coverage under basic, limited, and single health care plans.
(b) A health maintenance organization is subject to:
(1) Chapter 402;
(2) Chapter 827 and is an authorized insurer for purposes of that chapter; and
(3) Subchapter G, Chapter 1251, and Section 1551.064.
(c) Except as otherwise provided by this chapter or other law, insurance laws and group hospital service corporation laws do not apply to a health maintenance organization that holds a certificate of authority under this chapter. This subsection applies to an insurer or a group hospital service corporation only with respect to the health maintenance organization activities of the insurer or corporation.
(d) Activities permitted under other chapters of this code are not subject to this chapter.
(e) Except for Chapter 251, as applicable to a third-party administrator, and Chapters 259, 4151, and 4201, insurance laws and group hospital service corporation laws do not apply to a physician or provider. Notwithstanding this subsection, a physician or provider who conducts a utilization review during the ordinary course of treatment of patients under a joint or delegated review agreement with a health maintenance organization on services provided by the physician or provider is not required to obtain certification under Subchapter C, Chapter 4201.
(f) A health maintenance organization is subject to Chapter 823 as if the health maintenance organization were an insurer under that chapter.
(g) The merger of a health maintenance organization with another health maintenance organization is subject to Chapter 824 as if the health maintenance organizations were insurance corporations under that chapter. The commissioner may adopt rules as necessary to implement this subsection in a way that reflects the nature of health maintenance organizations, health care plans, or evidences of coverage.
Added by Acts 2001, 77th Leg., ch. 1419, Sec. 1, eff. June 1, 2003.
Amended by:
Acts 2005, 79th Leg., Ch. 364 (S.B. 1284), Sec. 1, eff. September 1, 2005.
Acts 2007, 80th Leg., R.S., Ch. 730 (H.B. 2636), Sec. 2E.033, eff. April 1, 2009.
Section: Previous 843.004 843.005 843.006 843.007 843.008 843.009 843.010 843.051 843.052 843.053 843.054 843.055 843.056 843.071 843.072 NextLast modified: September 28, 2016