Texas § 1456.002 APPLICABILITY OF CHAPTER.

Texas Statutes

§ 1456.002 — APPLICABILITY OF CHAPTER.

Texas § 1456.002

Code INInsurance Code

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Bluebook

Tex. Insurance Code Code Ann. § 1456.002 (2026).

Text

Sec. 1456.002. APPLICABILITY OF CHAPTER.

(a)This chapter applies to any health benefit plan that:

(1)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 that is offered by:

(A)an insurance company;

(B)a group hospital service corporation operating under Chapter 842 ;

(C)a fraternal benefit society operating under Chapter 885 ;

(D)a stipulated premium company operating under Chapter 884 ;

(E)a health maintenance organization operating under Chapter 843 ;

(F)a multiple employer welfare arrangement that holds a certificate of authority under Chap

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Sec. 1456.002. APPLICABILITY OF CHAPTER. (a) This chapter applies to any health benefit plan that:
(1) 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 that is offered by:
(A) an insurance company;
(B) a group hospital service corporation operating under Chapter 842 ;
(C) a fraternal benefit society operating under Chapter 885 ;
(D) a stipulated premium company operating under Chapter 884 ;
(E) a health maintenance organization operating under Chapter 843 ;
(F) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 ;
(G) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 ; or
(H) an entity not authorized under this code or another insurance law of this state that contracts directly for health care services on a risk-sharing basis, including a capitation basis; or
(2) provides health and accident coverage through a risk pool created under Chapter 172 , Local Government Code, notwithstanding Section 172.014 , Local Government Code, or any other law.
(b) This chapter applies to a person to whom a health benefit plan contracts to:
(1) process or pay claims;
(2) obtain the services of physicians or other providers to provide health care services to enrollees; or
(3) issue verifications or preauthorizations.
(c) This chapter does not apply to:
(1) Medicaid managed care programs operated under Chapter 540 or 540A , Government Code, as applicable;
(2) Medicaid programs operated under Chapter 32 , Human Resources Code; or
(3) the state child health plan operated under Chapter 62 or 63 , Health and Safety Code.

Legislative History

Added by Acts 2007, 80th Leg., R.S., Ch. 997 (S.B. 1731 ), Sec. 11, eff. September 1, 2007. Amended by: Acts 2023, 88th Leg., R.S., Ch. 769 (H.B. 4611 ), Sec. 2.134, eff. April 1, 2025.