Sec. 1366.053. APPLICABILITY OF SUBCHAPTER  


Latest version.
  • This subchapter applies only to a health benefit plan 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 stipulated premium company operating under Chapter 884; or

    (v) a health maintenance organization operating under Chapter 843; and

    (B) to the extent permitted by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 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;

    (ii) 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

    (iii) another analogous benefit arrangement; or

    (2) is offered by an approved nonprofit health corporation that holds a certificate of authority under Chapter 844.

Added by Acts 2003, 78th Leg., ch. 1274, Sec. 3, eff. April 1, 2005.