Texas Insurance Code 1222.0002 – Applicability of Chapter
(a) This chapter applies only to a health benefit plan that 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 or similar coverage document that is issued by:
(1) an insurance company;
(2) a group hospital service corporation operating under Chapter 842;
(3) a health maintenance organization operating under Chapter 843;
(4) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844;
(5) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846;
(6) a stipulated premium company operating under Chapter 884;
(7) a fraternal benefit society operating under Chapter 885;
(8) a Lloyd’s plan operating under Chapter 941; or
(9) an exchange operating under Chapter 942.
Text of subsection effective until April 01, 2025
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter 1601;
(7) health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;
(8) group health coverage made available by a school district in accordance with § 22.004, Education Code;
(9) the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;
(10) the child health plan program under Chapter 62, Health and Safety Code;
(11) a regional or local health care program operated under § 75.104, Health and Safety Code; and
(12) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.
Text of subsection effective on April 01, 2025
Terms Used In Texas Insurance Code 1222.0002
- 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.
(b) Notwithstanding any other law, this chapter applies to:
(1) a small employer health benefit plan subject to Chapter 1501, including coverage provided through a health group cooperative under Subchapter B of that chapter;
(2) a standard health benefit plan issued under Chapter 1507;
(3) a basic coverage plan under Chapter 1551;
(4) a basic plan under Chapter 1575;
(5) a primary care coverage plan under Chapter 1579;
(6) a plan providing basic coverage under Chapter 1601;
(7) health benefits provided by or through a church benefits board under Subchapter I, Chapter 22, Business Organizations Code;
(8) group health coverage made available by a school district in accordance with § 22.004, Education Code;
(9) the state Medicaid program, including the Medicaid managed care program operated under Chapters 540 and 540A, Government Code;
(10) the child health plan program under Chapter 62, Health and Safety Code;
(11) a regional or local health care program operated under § 75.104, Health and Safety Code; and
(12) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code.