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Texas Statutes (Last Updated: January 4, 2014) |
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INSURANCE CODE |
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Title 8. HEALTH INSURANCE AND OTHER HEALTH COVERAGES |
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Subtitle F. PHYSICIANS AND HEALTH CARE PROVIDERS |
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Chapter 1453. DISCLOSURE OF REIMBURSEMENT GUIDELINES UNDER MANAGED CARE PLAN |
Sec. 1453.001. DEFINITIONS
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In this chapter:
(1) "Health care provider" means:
(A) a hospital, emergency clinic, outpatient clinic, or other facility providing health care services; or
(B) an individual who is licensed in this state to provide health care services.
(2) "Managed care entity" means:
(A) a health maintenance organization;
(B) a preferred provider benefit plan issuer;
(C) an approved nonprofit health corporation that holds a certificate of authority under Chapter 844; or
(D) another entity that offers a managed care plan, including:
(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;
(v) a multiple employer welfare arrangement that holds a certificate of authority under Chapter 846; and
(vi) 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.
(3) "Managed care plan" means a health benefit plan:
(A) under which health care services are provided through contracts with health care providers to individuals enrolled in or insured under the plan; and
(B) that provides financial incentives to individuals enrolled in or insured under the plan to use health care providers participating in the plan and procedures covered by the plan.