§ 1380.002 — APPLICABILITY OF CHAPTER.

Texas § 1380.002

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 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 Chapters 540 and 540A , 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 Section 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.

Legislative History

Added by Acts 2023, 88th Leg., R.S., Ch. 1155 (S.B. 1040 ), Sec. 1, eff. September 1, 2023. Amended by: Acts 2025, 89th Leg., R.S., Ch. 204 (H.B. 1620 ), Sec. 11.009, eff. September 1, 2025.