Texas Insurance Code 1205.001 – Applicability of Chapter
Terms Used In Texas Insurance Code 1205.001
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
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. § 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.