§ 1661.001 — DEFINITIONS.

Texas § 1661.001

• Jurisdiction: Texas
• Code IN: Insurance Code

Text

Sec. 1661.001. DEFINITIONS. In this chapter:
(1) "Health benefit plan" means a 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 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 Lloyd's plan operating under Chapter 941 ;
(F) an exchange operating under Chapter 942 ;
(G) a health maintenance organization operating under Chapter 843 ;
(H) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846 ;
(I) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844 ; or
(J) 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.
(2) "Health benefit plan issuer" means an entity authorized to issue a health benefit plan in this state.
(3) "Health care provider" means:
(A) an individual who is licensed, certified, or otherwise authorized to provide health care services; or
(B) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services.
(4) "Participating provider" means a health care provider who has contracted with a health benefit plan issuer to provide services to enrollees.

Legislative History

Added by Acts 2009, 81st Leg., R.S., Ch. 261 (H.B. 1342 ), Sec. 1, eff. May 30, 2009.