Texas Insurance Code 1363.001 – Applicability of Chapter
Terms Used In Texas Insurance Code 1363.001
- 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.
- Written: includes any representation of words, letters, symbols, or figures. See Texas Government Code 311.005
This chapter applies only to a health benefit plan, including a small employer health benefit plan written under Chapter 1501 or coverage that is provided by a health group cooperative under Subchapter B of that chapter, 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 Lloyd’s plan operating under Chapter 941;
(v) a stipulated premium company operating under Chapter 884;
(vi) a health maintenance organization operating under Chapter 843; or
(vii) a reciprocal or interinsurance exchange operating under Chapter 942; 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; or
(ii) another analogous benefit arrangement;
(2) is offered by an approved nonprofit health corporation operating under Chapter 844; or
(3) provides health and accident coverage through a risk pool created under Chapter 172, Local Government Code, notwithstanding § 172.014, Local Government Code, or any other law.