Texas Insurance Code 1380.002 – 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 offered 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.
(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) the state Medicaid program, including the Medicaid managed care program operated under Chapter 533, Government Code;
(9) the child health plan program under Chapter 62, Health and Safety Code;
(10) a regional or local health care program operated under § 75.104, Health and Safety Code;
(11) a self-funded health benefit plan sponsored by a professional employer organization under Chapter 91, Labor Code;
(12) county employee group health benefits provided under Chapter 157, Local Government Code; and
(13) health and accident coverage provided by a risk pool created under Chapter 172, Local Government Code.
Terms Used In Texas Insurance Code 1380.002
- 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.